Qualitative assessment of cause-of-injury coding in U.S. military hospitals: NATO standardization agreement (STANAG) 2050.
BACKGROUND
Accurate injury cause data are essential for injury prevention research. U.S. military hospitals, unlike civilian hospitals, use the NATO STANAG system for cause-of-injury coding. Reported deficiencies in civilian injury cause data suggested a need to specifically evaluate the STANAG.


METHODS
The Total Army Injury and Health Outcomes Database (TAIHOD) was used to evaluate worldwide Army injury hospitalizations, especially STANAG Trauma, Injury, and Place of Occurrence coding. We conducted a review of hospital procedures at Tripler Army Medical Center (TAMC) including injury cause and intent coding, potential crossover between acute injuries and musculoskeletal conditions, and data for certain hospital patients who are not true admissions. We also evaluated the use of free-text injury comment fields in three hospitals.


RESULTS
Army-wide review of injury records coding revealed full compliance with cause coding, although nonspecific codes appeared to be overused. A small but intensive single hospital records review revealed relatively poor intent coding but good activity and cause coding. Data on specific injury history were present on most acute injury records and 75% of musculoskeletal conditions. Place of Occurrence coding, although inherently nonspecific, was over 80% accurate. Review of text fields produced additional details of the injuries in over 80% of cases.


CONCLUSIONS
STANAG intent coding specificity was poor, while coding of cause of injury was at least comparable to civilian systems. The strengths of military hospital data systems are an exceptionally high compliance with injury cause coding, the availability of free text, and capture of all population hospital records without regard to work-relatedness. Simple changes in procedures could greatly improve data quality.
Amoroso
P J
PJ
U.S. Army Research Institute for Environmental Medicine (Amoroso), Natick, Massachusetts, USA. paul.amoroso@na.amedd.army.mil
Smith
G S
GS
Bell
N S
NS
D015984:Causality; D003953:Diagnosis-Related Groups / Q000592:standards*; D006753:Hospital Records / Q000592:standards; D006772:Hospitals, Military; D006801:Humans; D007391:International Cooperation; D008889:Military Personnel / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D014481:United States; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology* / Q000517:prevention & control