title: The pyramid of injury: using ecodes to accurately describe the burden of injury.
abstract: OBJECTIVE
  Although much is known about injury-related deaths from the use of external cause of injury codes (ecodes) on death certificates, the contribution of nonfatal injury is unknown, with most information based on estimates from national surveys. Some states mandate ecoding of charts for hospitalized patients, but few require ecode assignment for emergency department (ED) records. Missouri and Nebraska mandated ecoding of ED records in 1993 and 1994, respectively, allowing for a more complete description of injuries in those states. We describe fatal and nonfatal injury frequencies in Missouri and Nebraska by using ecodes, with graphic representation in the form of injury pyramids.
  
  
  METHODS
  Ecode frequencies for 1996 to 1998 for all injury causes in Missouri and Nebraska were reported directly from their respective health departments. The ecode frequencies were grouped according to the Centers for Disease Control and Prevention's ecode matrix for presenting injury and mortality data.
  
  
  RESULTS
  During the study period, 13,052 deaths, 131,210 hospitalizations, and 1,914,140 ED visits occurred as the result of injury. The most frequent lethal injuries were unintentional motor vehicle crashes (32.3% of total deaths), self-inflicted gunshot wound (13.2%), unintentional falls (11.3%), gunshot wound from an assault (7.7%), and unintentional poisoning (4.3%). The leading causes of injury-related hospitalization were unintentional falls (47.8% of total hospitalizations), unintentional motor vehicle crashes (15.5%), self-inflicted poisoning (6.5%), and overexertion or strenuous movements (2.4%). Of 1.9 million ED injury visits, unintentional falls accounted for 24.3%, unintentionally being struck by an object or person for 14.6%, unintentional motor vehicle crashes for 11.4%, unintentionally being cut or pierced for 10.7%, and overexertion or strenuous movements for 8.5%.
  
  
  CONCLUSIONS
  Ecoding in Missouri and Nebraska provides a comprehensive data retrieval system that allows for a graphic depiction of the burden of injury derived from real patient encounters within specific geographic regions.
authors.affiliation: Department of Surgery, Section of Emergency Medicine, 981150 University of Nebraska Medical Center, Omaha, NE 681198-1150, USA. mwadman@unmc.edu
authors.forename: Michael C
authors.initials: MC
authors.lastname: Wadman
authors.forename: Robert L
authors.initials: RL
authors.lastname: Muelleman
authors.forename: J Arturo
authors.initials: JA
authors.lastname: Coto
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Kellermann
mesh_terms: D016009:Chi-Square Distribution; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008923:Missouri / Q000453:epidemiology; D009329:Nebraska / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D012042:Registries; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology* / Q000209:etiology