Classification of death and injury due to terrorism - PowerPoint PPT Presentation

Classification of death and injury due to terrorism

Lois A. Fingerhut & NCHS Colleagues….

May, 2002

National Center for Health Statistics, CDC

• Donna Pickett
• Donna Hoyert
• Donna Glenn
• Harry Rosenberg
• Bob Anderson
• Cathy Burt, Bob Pokras, Amy Blum
• Mary Anne Freedman,Marjorie Greenberg, Ed Hunter
• Office of the Center Director, NCHS

• Department of Justice- FBI
• Department of Justice- Bureau of Justice Statistics
• Centers within CDC
• WHO:
• Mortality Reference Group
• WHO Update Reference Committee
• Heads of WHO Collaborating Centres for the Classification of Diseases
• Individuals developing the National Violent Death Reporting System
• Injury Control and Emergency Health Services Section of the American Public Health Association
• President of the National Association of Medical Examiners

• “…the unlawful use of force or violence against persons or property to intimidate or coerce a Government, the civilian population, or any segment thereof, in furtherance of political or social objectives.”
• Code of Federal Regulations (28 C.F.R. Section 0.85)

• Neither medical examiners nor medical record coders will be responsible for determining whether or not a death or injury resulted from terrorism.
• All decisions will be made by ‘the federal government’ (FBI).
• This will be more difficult for morbidity data if an “event” is labeled “terrorist” after the fact.

• Classify terrorism with new ICD-10 codes for mortality and tabulate as an underlying cause of death within the categories of homicide or suicide, as appropriate.
• Place terrorism-related ICD-10 codes for mortality in the “U” Chapter of ICD-10, which has been reserved for “future additions and changes and for possible interim classifications to solve difficulties arising at the national and international levels between revisions.”

• New ICD-10 terrorism codes for mortality are to be tabulated for statistical purposes within the category of homicide, thus expanding the current codes from X85-Y09, Y87.1 to include *U01 and *U02.
• ICD-10 Codes *U03.1 and *U03.9 are to be tabulated for statistical purposes within the category of suicide, expanding the current codes from X60-X84, Y87.0 to include *U03.

• Use ICD-10 code(s) Y08- Assault by other specified means, or Y09- Assault (homicide) by unspecified means, or X83 or X84, Intentional self-harm (suicide) by other specified or unspecified means, respectively for deaths for which terrorism has not been established at the time the death certificate is initially filed.

• *U01 Terrorism
• *U01.0 Terrorism involving explosion of marine weapons
• *U01.1 Terrorism involving destruction of aircraft
• *U01.2 Terrorism involving other explosions and fragments
• *U01.3 Terrorism involving fires, conflagration and hot substances
• *U01.4 Terrorism involving firearms
• *U01.5 Terrorism involving nuclear weapons
• *U01.6 Terrorism involving biological weapons
• *U01.7 Terrorism involving chemical weapons
• *U01.8 Terrorism, other specified
• *U01.9 Terrorism, unspecified

• *U02 Sequelae of terrorism
• *U03 Terrorism
• *U03.0 Terrorism involving explosions and fragments
• *U03.9 Terrorism by other and unspecified means

• *U01.7 Terrorism involving chemical weapons
• Gases, fumes and chemicals
• Hydrogen cyanide
• Phosgene
• Sarin

Accidents (unintentional injuries) (V01-X59, Y85-Y86)

Transport accidents (V01-V99, Y85)

“ “ “

Intentional self-harm (suicide) (X60-X84, Y87.0)

Intentional self-harm (suicide) by

discharge of firearms (X72-X74)

Intentional self-harm (suicide) by other

and unspecified means and their

sequelae (X60-X71, X75-X85, Y87.0)

Assault (homicide) (X85-Y09, Y87.1)

Assault (homicide) by discharge of

firearms ( X93-X95)

Assault (homicide) by other and

unspecified means and their

sequelae (X85-X92, X96-Y09, Y87.1)

Legal intervention (Y35, Y89.0)

Plus terrorism codes

Accidents (unintentional injuries) (V01-X59, Y85-Y86)

Transport accidents (V01-V99, Y85)

“ “ “

Intentional self-harm (suicide) (X60-X84, Y87.0, *U03)

Intentional self-harm (suicide) by

discharge of firearms (X72-X74)

Intentional self-harm (suicide) by other and unspecified means and their

sequelae (X60-X71, X75-X85, Y87.0, *U03)

Assault (homicide)(X85-Y09, Y87.1, *U01-*U02)

Assault (homicide) by discharge of

firearms (X93-X95)

Assault (homicide) by other and

unspecified means and their sequelae(X85-

X92, X96-Y09, Y87.1, *U01-*U02)

Legal intervention (Y35, Y89.0)

• Through the Division of Vital Statistics
• To State vital statistics offices for immediate implementation through an addendum to its vital statistics instruction manuals
• Beginning with September 11 deaths
• NCHS will recode those deaths that have not been classified using new codes
• Amended tabulation lists will appear in NCHS reports for 2001 data year

• Place terrorism codes for morbidity within the framework of ICD-9-CM.
• Unlike the placement of the mortality codes, which are in a new chapter (“U”), the codes for morbidity are within the existing chapter for External Causes of Morbidity.

• Use the new ICD-9-CM codes

E979.0-E979.9 and E999.0-E999.1 for nonfatal injuries resulting from terrorism.

• For statistical purposes these codes will be tabulated within the category for assault, expanding the current category from E960-E969 to include E979 and E999.
• At this time, NCHS is not recommending a parallel category for self-inflicted injury.

• E979.0 Terrorism involving explosion of marine weapons
• E979.1 Terrorism involving destruction of aircraft
• E979.2 Terrorism involving other explosions and fragments
• E979.3 Terrorism involving fires, conflagration, and hot substances
• E979.4 Terrorism involving firearms
• E979.5 Terrorism involving nuclear weapons
• E979.6 Terrorism involving biological weapons
• E979.7 Terrorism involving chemical weapons
• E979.8 Terrorism involving other means
• E979.9 Terrorism, secondary effects
• E999 Late effect of injury due to war operations and terrorism
• E999.0 Late effect of injury due to war operations
• E999.1 Late effect of injury due to terrorism

• Through its Data Policy and Standards Staff
• Notice to be published in the Federal Register to announce the availability of the new codes to the health care community.
• Codes become effective Oct.1, 2002
• Dissemination to the American Hospital Association, the American Health Information Management Association, State health information professional organizations, book publishers, and data system vendors.

Complete documentation can be found:

NCHS web site

Disease Classification

http://www.cdc.gov/nchs/about/otheract/icd9/terrorism_code.htm