Carbon Monoxide-Related Injury Estimation Using ICD-Coded Data: Methodologic Implications for Public Health Surveillance
- 1 May 2005
- journal article
- Published by Taylor & Francis Ltd in Archives of Environmental & Occupational Health
- Vol. 60 (3), 119-27
- https://doi.org/10.3200/aeoh.60.3.119-127
Abstract
Estimates of unintentional deaths from carbon monoxide (CO) poisoning can be obtained from national mortality data. We explored ways of accurately estimating CO-related deaths from International Classification of Diseases, 9th Revision (ICD-9) coded U.S. mortality data. We evaluated and identified CO-related ICD-9 codes and created five classes of codes for case ascertainment that represented a continuum of the degree of certainty that the ICD-coded death was truly CO-related. We conducted single (underlying) cause-of-death and multiple-cause-of-death analysis using 20 years of data (1979-1998), and calculated sensitivity and positive predictive value using different criteria for case ascertainment. Single-cause analysis provided accurate estimates only when we used CO-exclusive E-codes, however this method failed to identify approximately one third of the CO-related deaths over the study period. Single-cause analysis overestimated the number of CO-related deaths when we used E-codes that were not exclusive to CO exposure. Identification of true CO-related deaths required multiple cause-of-death analysis and use of the CO nature-of-injury code, N986, to confirm suspected cases. Sensitivity of N986 was 99.5%, and positive predictive value of the individual E-codes in single cause-of-death analysis ranged from 1.5% to 92%. Estimating CO-related deaths from ICD-coded data requires a thorough understanding of the ICD codes, coding rules, and of the limitations imposed by case selection criteria and single cause-of-death analysis.Keywords
This publication has 21 references indexed in Scilit:
- Hyperbaric Oxygen for Acute Carbon Monoxide PoisoningNew England Journal of Medicine, 2002
- National Vehicle Emissions Policies and Practices and Declining US Carbon Monoxide–Related MortalityJama-Journal Of The American Medical Association, 2002
- Surveillance for carbon monoxide poisoning using a national media clipping serviceThe American Journal of Emergency Medicine, 2001
- Hyperbaric oxygen for carbon monoxide poisoningPublished by Wiley ,2000
- An outbreak of carbon monoxide poisoning after a major ice storm in MaineThe Journal of Emergency Medicine, 2000
- Carbon monoxide poisoning: a review for cliniciansThe Journal of Emergency Medicine, 1999
- “Sensitivity” and “Specificity” Reconsidered: The Meaning of These Terms in Analytical and Diagnostic SettingsAnnals of Internal Medicine, 1997
- Unintentional carbon monoxide poisoning in Colorado, 1986 through 1991.American Journal of Public Health, 1995
- Fatal unintended carbon monoxide poisoning in West Virginia from nonvehicular sources.American Journal of Public Health, 1989
- Unintentional deaths from carbon monoxide in motor vehicle exhaust: West Virginia.American Journal of Public Health, 1989