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Revised Framework of External Cause of Injury (E code) Groupings for Presenting Injury Mortality and Morbidity Data


Over the past few years, the injury prevention community has expressed the need to define standard groupings of International Classification of Disease, 9th revision (ICD-9) and Clinical Modification (ICD-9-CM) external cause of injury codes (E codes) for presenting injury mortality and morbidity data, respectively. A framework of E code groupings will improve the usefulness of external cause of injury data for research, surveillance, and prevention activities. Common definitions of external cause categories and uniform presentation of data will help provide a better understanding of the scope of the injury problem in the United States and internationally and allow for comparisons of injury rates among states and communities.

Establishing cause-specific E code groupings will help provide a minimum framework for reporting injury data that goes beyond what has been traditionally available. For instance, injury mortality data often have been published only in broad categories: "motor vehicle accidents," "all other accidents and adverse effects," homicide, and suicide. The latter three categories represent aggregates of many different types of injury mechanisms (e.g., cutting/piercing instrument, drowning, falls, firearms, poisoning, suffocation). These more detailed, cause-specific injury data are needed for monitoring the occurrence and outcomes of injury and for evaluating the effectiveness of prevention and intervention program at the national, state and community levels and internationally.

At the 1993 Annual Meeting of the American Public Health Association, the Injury Control and Emergency Health Services (ICEHS) section endorsed a project to develop the framework. The American Health Information Management Association (AHIMA) and the Central Office of ICD-9-CM of the American Hospital Association have also endorsed this effort.

The National Center for Injury Prevention and Control (NCIPC) and the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention have been collaborating with members of the ICEHS in developing proposed E code groupings. In July, 1995, two documents (1,2) presenting draft E code groupings for mortality and morbidity data were circulated to 650 public health professionals, health care providers, vital statisticians, medical coders, and injury epidemiologists and researchers for review and comment. Comments were received from about 90 respondents representing various disciplines and organizations across the nation. These comments were presented and discussed during a ICEHS-sponsored round table session at the APHA meeting in San Diego, California in November, 1995. Discussions at the round table session focused on proposed framework of E code groupings presented in the form of a matrix table. The matrix table shows E codes grouped according to the two E code classification axes: mechanism of injury or cause of death (e.g., falls, fires/burns, firearms, poisoning, and suffocation) by intent of injury or manner of death (i.e., unintentional or "accidental," intentionally self-inflicted, intentionally inflicted by another, legal intervention, intent undetermined, and operations of war).

A presentation about the framework was also made at the annual meeting of project managers for the Vital Statistics Cooperative Program in March 1996 and was generally well-received.

In the April, 1996, proposed matrix tables for presenting injury mortality and morbidity data were released for review and comment on the NCIPC home page. In November 1996, the proposed E code groupings were again presented for review and discussed at a workshop of the International Collaborative Effort on Injury Statistics and at the annual APHA meeting. Suggestions and recommendations from these discussions were used to refine E code groupings and update the framework for tabulating injury mortality and morbidity data.

In August, 1997, an MMWR article was published providing the recommended framework for presenting injury mortality data (3). This report provides a matrix table of E code groupings by mechanism and intent of injury and describes the composition of each grouping. Many researchers have been using this matrix to also present injury morbidity data based on ICD-9-CM codes. However, there are a few additional codes that need to be considered when using the framework for injury morbidity data. Table 1 presents these additional ICD-9-CM codes (created since 1995) that do not fall into any of the major E code groupings. These are indicated in bold in the Table and are described in a footnote. These bolded E codes only apply to injury morbidity data.

We hope this Table is useful to you in your data presentations. If you have any other questions, please contact:

Lee Annest, Ph.D.
Director, Office of Statistic and Programming
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention (CDC)
4770 Buford Hwy, NE, MS/K59
Atlanta, GA 30341-3724
FAX 770-488-1665


  1. Berenholz G. Draft recommendations report of standard e-code groupings. Unpublished report. Lexington, MA: Berenholz Consulting Associates, July 1995.
  2. McLoughlin E, Fingerhut L, Weiss H, Annest L. A proposed mechanism/intent matrix for presenting E-coded data. Unpublished report. Atlanta GA: National Center for Injury Prevention and Control, July 1995.
  3. McLoughlin E, Annest JL, Fingerhut LA, Rosenberg HM, Kochanek KD, Pickett D, and Berenholz. Recommended framework for presenting injury mortality data. MMWR Recommendations and Reports, Vol. 46, No. RR-14, August, 1997.
Content Source: National Center for Injury Prevention and Control, Division of
Page last modified: April 08, 2008