Abstract
BackgroundWe aimed to estimate the impact of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding transition on traumatic injury-related hospitalization trends among young adults across a geographically and demographically diverse group of U.S. states.MethodsInterrupted time series analyses were conducted using statewide inpatient databases from 12 states and including traumatic injury-related hospitalizations in adults aged 19–44 years in 2011–2017. Segmented regression models were used to estimate the impact of the October 2015 coding transition on external cause of injury (ECOI) completeness (percentage of hospitalizations with a documented ECOI code) and on population-level rates of injury-related hospitalizations by nature, intent, mechanism, and severity of injury.ResultsThe transition to ICD-10-CM was associated with a drop in ECOI completion in the transition month (− 3.7%; P < .0001), but there was no significant change in the positive trend in ECOI completion from the pre- to post-transition periods. There were significant increases post-transition in the measured rates of hospitalization for traumatic brain injury (TBI), unintentional injury, mild injury (injury severity score (ISS) < 9), and injuries caused by drowning, firearms, machinery, other pedestrian, suffocation, and unspecified mechanism. Conversely, there were significant decreases in October 2015 in the rates of hospitalization for assault, injuries of undetermined intent, injuries of moderate severity (ISS 9–15), and injuries caused by fire/burn, other pedal cyclist, other transportation, natural/environmental, and other specified mechanism. A significant increase in the percentage of hospitalizations classified as resulting from severe injury (ISS > 15) was observed when the general equivalence mapping maximum severity method for converting ICD-10-CM codes to ICD-9-CM codes was used. State-specific results for the outcomes of ECOI completion and TBI-related hospitalization rates are provided in an online supplement.ConclusionsThe U.S. transition from ICD-9-CM to ICD-10-CM coding led to a significant decrease in ECOI completion and several significant changes in measured rates of injury-related hospitalizations by injury intent, mechanism, nature, and severity. The results of this study can inform the design and analysis of future traumatic injury-related health services research studies that use both ICD-9-CM and ICD-10-CM coded data.Level of evidenceII (Interrupted Time Series)
Highlights
We aimed to estimate the impact of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding transition on traumatic injury-related hospitalization trends among young adults across a geographically and demographically diverse group of U.S states
The U.S transition from ICD-9-CM to ICD-10-CM coding led to a significant decrease in external cause of injury (ECOI) completion and several significant changes in measured rates of injury-related hospitalizations by injury intent, mechanism, nature, and severity
In analyses stratified by state, the immediate drop in ECOI completion associated with the October 2015 transition was significant in 7 of the 12 states, with level drops ranging from − 2.8% in New Jersey (p < 0.0001) to − 22.8% in Nevada (p < 0.0001) (Additional file 2, Figures A2.1–2 and Table A2.1)
Summary
We aimed to estimate the impact of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding transition on traumatic injury-related hospitalization trends among young adults across a geographically and demographically diverse group of U.S states. To facilitate injury research and surveillance after the coding system transition, the Centers for Disease Control and Prevention (CDC) proposed new ICD-10-CM injury surveillance frameworks to replace the widely used ICD-9-CM ECOI and injury diagnosis (nature and body region of injury) matrices (Hedegaard et al 2016; Annest et al 2014; Barell et al 2002). No studies have used the CDC’s final ECOI matrix to examine the effects of the transition to ICD-10-CM on rates of hospitalizations coded as traumatic-injury related in a multi-state cohort. The extent to which the transition has impacted apparent traumatic injury hospitalization trends by severity or nature of injury, as determined from injury diagnosis codes, has not been described
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