Etiology of nonspecific cause of death coding in New York City motor vehicle crash-related fatalities.
OBJECTIVE
Nearly 20 percent of New York City's (NYC) accidental deaths are related to motor vehicles crashes (MVCs). Detailed International Classification of Disease (ICD-10; World Health Organization [WHO] 2007) cause-of-death coding of MVC-related fatalities improves surveillance and resulting identification of prevention strategies. We investigated ICD-10 codes in these fatalities and the potential to make them more specific.


METHODS
We defined "nonspecific" MVC ICD-10 codes as all globally unspecific codes (V870-V878, V892) and any codes with nonspecific components regarding vehicle involved, decedent position in vehicle, or MVC setting. We calculated nonspecific-code frequency for 1999-2008 MVC deaths. We reviewed a random 10 percent sample of 2007-2008 MVC deaths (N=61) and medical examiner (ME) records of all nonspecific death certificates (N=52), including police accident reports ("full PAR") and summaries prepared by onsite police officers ("brief PAR") to determine whether MEs had sufficient information available but did not include that information at death certification.


RESULTS
Among 1999-2008 NYC MVC deaths, 82.9 percent had nonspecific ICD-10 cause-of-death codes. Similarly, of the 61 recent randomly sampled MVC deaths, 52 (85.2%) had nonspecific codes. Of 52 nonspecific death certificates from the random sample, 38 (73.1%) death certificates had adequate information available on full or brief PAR to be more specific at the time of death certification. Consistent with MEs' reports of high reliance on the brief PAR, most nonspecific death certificates (76.9%) lacked adequate information in the brief PAR to be more specific.


CONCLUSIONS
Specific ICD-10 codes for MVC deaths depends on the level of detail provided by the ME in the "How Injury Occurred" and "If Transportation Injury Specify" death certificates sections. We have worked to ensure that key information is available to MEs in the brief PAR and educated MEs on the importance of this information to reduce the frequency of nonspecific codes and enhance injury prevention research.
New York City Department of Health and Mental Hygiene, Public Health/Preventive Medicine Residency, New York, New York 10007, USA. sayonemed@gmail.com
Sayone
S
Thihalolipavan
Ann
A
Madsen
Monica
M
Smiddy
Wenhui
W
Li
Elizabeth
E
Begier
Regina
R
Zimmerman
D000063:Accidents, Traffic / Q000401:mortality* / Q000706:statistics & numerical data; D002423:Cause of Death; D003644:Death Certificates; D006801:Humans; D018986:Motor Vehicles / Q000706:statistics & numerical data; D009519:New York City / Q000453:epidemiology