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3.1 Intent of Injury

For injury-related deaths, the intent of injury was determined according to the International Classification of Disease, 10th Revision⁷ (ICD-10) external cause of injury coded as the underlying cause (see Section 5.1 for more information about the source and coding of fatal injury data). The reportable intent categories are based on standard groupings of ICD-10 external cause codes in the external-cause-of-injury mortality matrix (http://www.cdc.gov/nchs/injury/injury_tools.htm). The reportable intent categories for injury-related deaths are shown below (Table 2).

For injuries resulting in hospitalization subsequent to emergency department (ED) treatment or injuries resulting in an ED visit followed by release (without hospitalization or other transfer), the intent of injury was assigned by trained hospital coders based on narrative information in the patient’s medical record (see Section 5.2 for more information about the underlying data). The assignment of injury intent is consistent with ICD-9-CM⁸ guidelines for coding intent of injury in morbidity data systems. The reportable intent categories for these injuries are shown below (Table 3).

The intent-of-injury reporting categories are defined as follows:

All Intents: This grouping combines all injury intent categories. For injury-related deaths it also includes injuries due to operations of war (which are not separately reportable).

Unintentional: This category refers to fatal and nonfatal injuries not deliberately inflicted, including any such injury described as an “accident,” regardless of whether inflicted by oneself or by another person. Injuries resulting in hospitalization subsequent to ED treatment or resulting in ED treatment only, and for which intent was not determined, are also included in this category as most such injuries were likely unintentional. (It should be noted that approximately 20% of nonfatal firearm-related injuries assigned to the “unintentional” category were cases with undetermined intent, based on a retrospective review of narratives describing the injury incidents. Cost estimates for nonfatal firearm-related injuries designated as “unintentional” should be interpreted with this in mind.)

Homicide/Assault: This category refers to fatal and nonfatal injuries due to acts of violence where physical force by one or more persons is used with the intent of causing harm, injury, or death to another person. Such injuries resulting in hospitalization subsequent to ED treatment or resulting in ED treatment only are reportable under the categories assault-other and assault-sexual, which include confirmed and suspected cases based on patient medical records.

Legal Intervention: This category refers to fatal and nonfatal injuries caused by police or other law enforcement agents in the course of official duties. For injury-related deaths this category includes state-sanctioned executions.

Suicide/Self-harm: This category refers to fatal and nonfatal injuries resulting from deliberate self-directed violence. For injuries resulting in hospitalization subsequent to ED treatment or resulting in ED treatment only, the self-harm category includes confirmed and suspected cases based on patient medical records.

Undetermined: This category is separately reportable only for injury-related deaths. It refers to instances in which the intent of injury was not determined. Injuries resulting in hospitalization subsequent to ED treatment or resulting in ED treatment only, and for which the intent was not determined, are included in the unintentional category.

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