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close this bookCDC's Short Version of the ICECI - International Classification of External Causes of Injury - A Pilot Test (Centers for Disease Control and Prevention, 2000, 30 p.)
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View the documentExecutive Summary
View the documentIntroduction
View the documentMethods and Procedures
View the documentResults
View the documentDiscussion
View the documentNext Steps for CDC’s Short ICECI
View the documentReferences

References

1. WHO-Working Group for Injury Surveillance Methodology Development and Its Technical Group. International Classification of External Causes of Injuries (ICECI). Amsterdam: Consumer Safety Institute, June 1999.

2. Holder Y, Krug E, et al. World Health Organization Injury Surveillance Guidelines for Less-Resourced Environments. Draft proposal released for comment at the 5th World Conference of Injury Prevention and Control; 2000 Mar 5–8; New Delhi (India). Atlanta, GA: National Center for Injury Prevention and Control, CDC, February 16, 2000.

3. Annest JL, Pogostin CL, Conn J, Fingerhut LA, Pickett D. Proposed short version of the International Classification of External Causes of Injuries (ICECI). Chapter 6. In: Proceedings of the International Collaborative Effort on Injury Statistics, Vol III, 2nd Symposium; 1999 June; Washington (DC). Available at www.cdc.gov/nchs/about/ otheract/ice/pro-iii.htm. Accessed April 2000.

4. Fleiss JL. Statistical Methods for Rates and Proportions. 2nd ed. New York, NY: John Wiley & Sons, 1981: 212–225.

5. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–174.

6. Fleiss JL, Nee JC, Landis JR. Large sample variance of kappa in the case of different sets of raters. Psychological Bulletin 1979;86:974–977.

7. Quinlan KP, Thompson MP, Annest JL, Peddicord J, Ryan G, Kessler EP, McDonald AK. Expanding the National Electronic Injury Surveillance System to monitor all nonfatal injuries treated in U.S. hospital emergency departments. Annals of Emergency Medicine 1999;34:637–645.

Table 1. Percent Observed Agreement among Massachusetts ED-SCIP Coders and between Coders and the Gold Standard for Five Major Data Elements, Overall and by Coder: 93 Injury-Related Case Scenarios, CDC’s Short ICECI Pilot Study


Inter-coder*

Gold/Coder A

Gold/Coder B

Gold/Coder C

Gold/Coder D

Gold/Overall

Data
Element

% Observed
Agreement

% Observed
Agreement

% Observed
Agreement

% Observed
Agreement

% Observed
Agreement

Average % Observed
Agreement

Work-Relatedness

97.8

94.6

94.6

95.7

91.4

94.1

Locale of Injury Incident

91.9

81.9

80.8

81.9

79.9

81.1

Activity at Time of Injury

85.7

80.7

86.2

77.5

79.7

81.0

Intent of Injury

96.9

89.3

91.4

89.2

90.3

90.1

Mechanism of Injury

86.5

76.6

87.4

79.7

78.8

80.6

* All four Massachusetts coders coded these 93 injury-related case scenarios. The inter-coder percent observed agreement was calculated as the percentage of cases where at least 3 of the 4 coders assigned the same code with respect to each of the five major data elements listed.

Table 2. Kappa Statistics* among Massachusetts ED-SCIP Coders and between Coders and the Gold Standard for Five Major Data Elements, Overall and by Coder: 93 Injury-Related Case Scenarios, CDC’s Short ICECI Pilot Study


Inter-coder

Gold/Coder A

Gold/Coder B

Gold/Coder C

Gold/Coder D

Gold/Overall

Data
Element

Kappa
(95% CI)

Kappa
(95% CI)

Kappa
(95% CI)

Kappa
(95% CI)

Kappa
(95% CI)

Average
Kappa

Work-Relatedness

81.1

84.0

83.4

86.5

76.4

82.4


(74.2-88.1)

(65.9-102)

(64.5-102)

(67.6-105)

(58.8-93.9)

(73.2-91.5)

Locale of Injury Incident

82.6

78.0

76.5

78.1

75.4

77.1


(79.2-85.9)

(69.7-86.3)

(68.2-84.9)

(69.9-86.4)

(67.2-83.7)

(72.9-81.2)

Activity at Time of Injury

73.6

77.6

83.8

73.9

76.3

77.9


(70.4-76.9)

(69.7-85.5)

(75.8-91.8)

(65.9-81.8)

(68.3-84.3)

(74.0-81.9)

Intent of Injury

89.7

81.2

84.3

80.3

82.5

82.1


(84.2-95.2)

(68.8-93.7)

(71.3-97.3)

(67.1-93.4)

(69.7-95.4)

(75.6-88.5)

Mechanism of Injury

79.7

72.8

85.1

76.3

75.3

77.4


(76.6-82.7)

(65.2-80.3)

(77.6-92.6)

(68.5-84.0)

(68.0-82.7)

(73.6-81.1)

* The kappa statistic measures the percent agreement beyond what can be expected by chance alone. Values of kappa >75% are considered to be excellent, and values between 40% and 75% represent fair to good agreement.5

The inter-coder kappa statistic measures agreement for all four coders simultaneously.

Table 3. Kappa Statistics* among NEISS Coders and between Coders and the Gold Standard for Five Major Data Elements, Overall and by Coder: 93 Injury-Related Case Scenarios, CDC’s Short ICECI Pilot Study


Inter-coder

Gold/Coder 1

Gold/Coder 2

Gold/Coder 3

Gold/Coder 4

Gold/Coder 5

Gold/Coder 6

Gold/Coder 7

Gold/Overall

Data
Element

Kappa
(95% CI)

Kappa
(95% CI)

Kappa
(95% CI)

Kappa
(95% CI)

Kappa
(95% CI)

Kappa
(95% CI)

Kappa
(95% CI)

Kappa
(95% CI)

Average
Kappa

Work- Relatedness

76.8

92.8

75.9

71.8

75.0

81.5

90.0

89.9

81.9


(72.9-80.6)

(72.5-113)

(58.1-93.6)

(55.0-88.6)

(56.0-94.0)

(63.3-99.6)

(69.6-110)

(70.1-110)

(74.8-88.9)

Locale of Injury Incident

71.4

69.8

70.4

74.2

66.4

64.2

68.6

58.0

67.4


(68.0-74.7)

(61.2-78.5)

(62.2-78.6)

(66.1-82.4)

(58.1-74.6)

(56.1-72.3)

(60.3-77.0)

(50.0-66.0)

(64.3-70.5)

Activity at Time of Injury

59.3

75.0

67.5

68.5

42.0

72.5

59.7

65.0

64.5


(54.4-64.2)

(67.0-83.0)

(59.4-75.5)

(60.2-76.7)

(33.8-50.2)

(64.4-80.6)

(51.5-67.9)

(56.9-73.0)

(61.4-67.5)

Intent of Injury

74.2

85.0

83.1

75.6

72.1

76.5

77.2

74.4

77.7


(71.5-76.9)

(72.3-97.6)

(70.7-95.6)

(63.2-88.0)

(59.7-84.6)

(64.2-88.8)

(64.5-89.9)

(61.9-86.9)

(73.0-82.4)

Mechanism of Injury

59.7

67.4

65.9

65.2

54.9

53.2

58.1

55.7

60.1


(56.4-62.9)

(59.7-75.1)

(57.5-74.2)

(57.7-72.7)

(47.1-62.6)

(45.3-61.0)

(50.4-65.8)

(47.9-63.5)

(57.2-63.1)

* The kappa statistic measures the percent agreement beyond what can be expected by chance alone. Values of kappa >75% are considered to be excellent, and values between 40% and 75% represent fair to good agreement.5

The inter-coder kappa statistic measures agreement for all 7 coders simultaneously.

Table 4. Comparison of Kappa Statistics* between Massachusetts ED-SCIP Coders and NEISS Coders for Five Major Data Elements: 93 Injury-Related Case Scenarios, CDC’s Short ICECI Pilot Study


Inter-coder
for MA

Inter-coder
for NEISS

% Difference
in Kappas

Gold/MA
Coder

Gold/NEISS
Coder

% Difference
in Kappas

Data
Element

Kappa

Kappa

(MA-NEISS)
NEISS

Average
Kappa

Average
Kappa

(MA-NEISS)
NEISS

Work-Relatedness

81.1

76.8

+5.6

82.4

81.9

+0.6

Locale of Injury Incident

82.6

71.4

+15.7

77.1

67.4

+14.4

Activity at Time of Injury

73.6

59.3

+24.1

77.9

64.5

+20.8

Intent of Injury

89.7

74.2

+20.9

82.1

77.7

+5.7

Mechanism of Injury

79.7

59.7

+33.5

77.4

59,1

+28.8

* The kappa statistic measures the percent agreement beyond what can be expected by chance alone. Values of kappa >75% are considered to be excellent, and values between 40% and 75% represent fair to good agreement.5

Table 5. Kappa Statistics* for Massachusetts ED-SCIP Coders for Five Major Data Elements, Overall and by Coder: 18 Injury-Related Case Scenarios Coded Twice by the Same Coder at Different Times, CDC’s Short ICECI Pilot Study


Coder A

Coder B

Coder C

Coder D

Intra-Coder Reliability

Data
Element

Kappa
(95% CI)

Kappa
(95% CI)

Kappa
(95% CI)

Kappa
(95% CI)

Average
Kappa

Work-Relatedness

87.7

100

67.2

79.3

83.2


(48.6-127)

(60.6-139)

(29.8-105)

(43.3-115)

(64.3-102)

Locale of Injury Incident

100

100

84.5

92.4

94.2


(77.7-122)

(77.7-122)

(60.7-108)

(70.4-114)

(83.1-105)

Activity at Time of Injury

93.1

86.0

72.2

100

88.0


(70.9-115)

(63.1-109)

(49.4-94.9)

(75.2-125)

(77.0-98.9)

Intent of Injury

82.7

81.6

90.8

90.8

86.4


(53.8-112)

(50.7-113)

(58.9-123)

(58.9-123)

(71.1-102)

Mechanism of Injury

70.8

77.7

78.6

70.3

74.4


(48.7-92.9)

(55.6-99.8)

(57.1-100)

(48.4-92.2)

(63.5-85.3)

* The kappa statistic measures the percent agreement beyond what can be expected by chance alone. Values of kappa >75% are considered to be excellent, and values between 40% and 75% represent fair to good agreement.5

Table 6. Kappa Statistics* among Randomly Selected Pairs of Massachusetts ED-SCIP Coders for Categories for Four Major Data Elements: 127 Injury-Related Hospital ED visits, CDC’s Short ICECI Pilot Study


Inter-coder Reliability

Data Element and Categories

Kappa (95% CI)



Work-Relatedness



Overall

67.1 (54.3–80.0)


Work-related

91.4 (74.0–109)


Not work-related

67.6 (50.1–85.1)



Locale of Injury Incident



Overall

73.5 (65.2–81.8)


Home/mobile home

83.5 (65.9–101)


Residential institution

100.0 (82.5–118)


Farm/ranch

-----


Street/highway

90.9 (73.4–108)


Trade and service area

66.0 (48.4–83.5)


Industrial/construction area

52.5 (34.9–70.0)


School/educational area

66.3 (48.7–83.8)


Other public building

100.0 (82.5–118)


Sports and athletic area

65.9 (48.3–83.4)



Activity at Time of Injury



Overall

67.5 (59.2–75.8)


Sports

92.9 (75.5–110)


Leisure

63.6 (46.2–81.0)


Traveling

85.7 (68.3–103)


Paid work

91.3 (73.9–109)


Unpaid work

48.4 (31.0–65.8)


Educational activity

-----


Vital activity

-----



Mechanism of Injury



Overall

91.4 (84.1–98.8)


Motor vehicle (occupant)

100.0 (82.5–117)


Pedestrian-vehicle crash

100.0 (82.5–117)


Motorcycle

-----


Pedal cycle

85.3 (67.9–103)


Struck by/against or crushed

83.5 (66.0–101)


Fall

94.1 (76.7–112)


Gunshot, firearm-related

-----


Stab/cut/pierce

89.5 (72.1–107)


Fire/burn

88.5 (71.0–106)


Smoke inhalation

-----


Poisoning

100.0 (82.5–117)


Near-drowning/drowning/submersion

-----


Foreign body

100.0 (82.5–117)


Overexertion

90.8 (73.3–108)

* The kappa statistic measures the percent agreement beyond what can be expected by chance alone. Values of kappa >75% are considered to be excellent, and values between 40% and 75% represent fair to good agreement.5

Intent of injury is not presented here because all but four cases were unintentional injuries; refer to Table 1 for percent observed agreement on this data element.

----- denotes that no cases were reported for this category.

Table 7. Description of Short ICECI Data for Injury-Related ED Patients Obtained from 16 Massachusetts ED-SCIP Hospitals: CDC’s Short ICECI Pilot Study


Number of

Percent

Data Element and Categories1

Patients

Distribution




Coding Time (in minutes)




Total

1,841

100.0



1 min

49

2.7



2 mins

17

28.1



3 mins

610

33.1



4 mins

323

17.5



5 mins

177

9.6



6 mins

38

2.1



7 mins

24

1.3



8 mins

26

1.4



9 mins

12

0.7



10 mins

15

0.8



11–18 mins

14

0.8



Not recorded/unknown

36

2.0




Sex of Patient




Total

1,841

100.0



Male

1,088

59.1



Female

748

40.6



Not stated/unknown

5

0.3




Age of Patient (in years)




Total

1,841

100.0



00–04 yrs

189

10.3



05–09 yrs

96

5.2



10–14 yrs

132

7.2



15–19 yrs

227

12.3



20–24 yrs

228

12.4



25–44 yrs

615

33.4



45–64 yrs

228

12.4



65+ yrs

115

6.2



Not stated/unknown

11

0.6




Work-Relatedness




Total

1,841

100.0



Work-related

272

14.8



Not work-related

1,210

65.7



Not recorded/unspecified

359

19.5




Locale of Injury Incident




Total

1,841

100.0



Home/mobile home

401

21.8



Residential institution

39

2.1



Farm/ranch

2

0.1



Street/highway

277

15.0



Trade and service area

115

6.2



Industrial/construction area

51

2.8



School/educational area

47

2.6



Other public building

20

1.1



Sports and athletic area

83

4.5



Other specified

82

4.5



Not recorded/unknown

724

39.3




Activity at Time of Injury




Total

1,841

100.0



Sports

150

8.1



Leisure

271

14.7



Traveling

233

12.7



Paid work

261

14.2



Unpaid work

66

3.6



Educational activity

4

0.2



Vital activity

29

1.6



Other specified

70

3.8



Not recorded/unspecified

757

41.1




Intent of Injury




Total

1,841

100.0



Unintentional

1,580

85.8



Intentionally self-inflicted

25

1.4



Assault, confirmed or suspected

200

10.9



Legal intervention

4

0.2



Operations of war and civil insurrection

-----*

-----



Not recorded/undetermined

2

1.7




Relationship of Perpetrator



to Victim for Assaults




Total

200

100.0



Spouse or partner

25

12.5



Parent

3

1.5



Other relative

11

5.5



Unrelated care giver

-----*

-----



Acquaintance or friend

17

8.5



Official/legal authorities

1

0.5



Multiple perpetrators

18

9.0



Stranger

25

12.5



Other specified person(s)

9

4.5



Not recorded/unknown

91

45.5




Reason for Assault




Total

200

100.0



Altercation

91

45.5



During illegal acquisition of

5

2.5




money or property





Drug-related

-----

-----



Sexual assault

7

3.5



Gang-related

-----

-----



Other specified

8

4.0



Not recorded/unknown

89

44.5




Mechanism of Injury




Total

1,841

100.0



Motor vehicle (occupant)

218

11.8



Pedestrian-vehicle crash

12

0.7



Motorcycle

21

1.1



Pedal cycle

20

1.1



Struck by/against or crushed

389

21.1



Fall

416

22.6



Gunshot, firearm-related

17

0.9



Stab/cut/pierce

294

16.0



Fire/burn

33

1.8



Smoke inhalation

1

0.1



Poisoning

35

1.9



Near-drowning/drowning/submersion

-----

-----



Foreign body

52

2.8



Overexertion

191

10.4



Other specified mechanism

132

7.2



Not recorded/undetermined

10

0.5




Traffic-Relatedness for



Motor Vehicle Occupants




Total

218

100.0



Traffic-related

197

90.4



Nontraffic-related

5

2.3



Not recorded/unknown

16

7.3




Type of Motor Vehicle that Patient



Was Riding




Total

218

100.0



Automobile

183

83.9



Pickup truck or van

8

3.7



Heavy transport vehicle

1

0.5



Bus

-----*

-----



3-wheel motor vehicle

1

0.5



Other specified

5

2.3



Not recorded/unknown

20

9.2




Motor Vehicle Occupant Status




Total

218

100.0



Driver

141

64.7



Passenger

69

31.7



Person boarding or alighting

1

0.5



Person on outside of motor vehicle

1

0.5



Not recorded

6

2.8




Counterpart for Motor Vehicle Crash



Involving Motor Vehicle Occupant




Total

218

100.0



Automobile

73

33.5



Pickup truck or van

3

1.4



Heavy transport vehicle

1

0.5



Bus

-----

-----



3-wheel motor vehicle

-----

-----



Motorcycle

-----

-----



Railway train/vehicle

-----

-----



Pedal cycle

-----

-----



Pedestrian

-----

-----



Animal or animal-drawn vehicle

-----

-----



Fixed or stationary object

33

15.1



No counterpart

16

7.3



Other specified

5

2.3



Not recorded/unknown

87

39.9




Traffic-Relatedness for



Pedestrian Injuries




Total

12

100.0



Traffic-related

9

75.0



Nontraffic-related

2

16.7



Not recorded/unknown

1

8.3




Counterpart for



Pedestrian-Vehicle Crash




Total

12

100.0



Automobile

8

66.7



Pickup truck or van

-----*

-----



Heavy transport vehicle

-----

-----



Bus

-----

-----



3-wheel motor vehicle

1

8.3



Motorcycle

2

16.7



Railway train/vehicle

-----

-----



Pedal cycle

-----

-----



Pedestrian

-----

-----



Animal or animal-drawn vehicle

-----

-----



Fixed or stationary object

-----

-----



No counterpart

-----

-----



Other specified

1

8.3



Not recorded/unknown

-----

-----




Traffic-Relatedness for



Motorcyclist Injuries




Total

21

100.0



Traffic-related

14

66.7



Nontraffic-related

2

9.5



Not recorded/unknown

5

23.8




Motorcyclist Status




Total

21

100.0



Driver

13

61.9



Passenger

8

38.1



Person boarding or alighting

-----

-----



Person on outside of motor vehicle

-----

-----



Not recorded/unknown

-----

-----




Counterpart for Motorcycle Crash




Total

21

100.0



Automobile

3

14.3



Pickup truck or van

-----*

-----



Heavy transport vehicle

-----

-----



Bus

-----

-----



3-wheel motor vehicle

-----

-----



Motorcycle

-----

-----



Railway train/vehicle

-----

-----



Pedal cycle

-----

-----



Pedestrian

1

4.8



Animal or animal-drawn vehicle

3

14.3



Fixed or stationary object

3

14.3



No counterpart

9

42.9



Other specified

-----

-----



Not recorded/unknown

2

9.5




Traffic-Relatedness for



Pedal Cyclist Injuries




Total

20

100.0



Traffic-related

8

40.0



Nontraffic-related

1

5.0



Not recorded/unknown

11

55.0




Counterpart for Pedal Cycle Crash




Total

20

100.0



Automobile

3

15.0



Pickup truck or van

-----

-----



Heavy transport vehicle

-----

-----



Bus

-----

-----



3-wheel motor vehicle

-----

-----



Motorcycle

-----

-----



Railway train/vehicle

-----

-----



Pedal cycle

-----

-----



Pedestrian

-----

-----



Animal or animal-drawn vehicle

1

5.0



Fixed or stationary object

2

10.0



No counterpart

13

65.0



Other specified

-----

-----



Not recorded/unknown

1

5.0




Source of Force Applied for



Struck By/Against Injuries




Total

389

100.0



Human

111

28.5



Animal

3

0.8



Inanimate object or force

256

65.8



Not recorded/unknown

19

4.9




Type of Force Applied for



Struck By/Against Injuries




Total

389

100.0



Struck by

219

56.3



Crushed by

63

16.2



Struck against

103

26.5



Not recorded/unknown

4

1.0




Type of Firearm Used in



Gunshot Injuries




Total

17

100.0



Handgun

7

41.2



Rifle

-----*

-----



Shotgun

1

5.9



Larger firearm

-----

-----



Not recorded/unknown

9

52.9




Type of Stabbing Weapon, Instrument,



or Object in Cut/Pierce Injuries




Total

294

100.0



Knife

68

23.1



Sharp instrument/tool other than knife

45

15.3



Sharp glass

40

13.6



Other specified

109

37.1



Not recorded/unknown

32

10.9




Type of Burn in Fire/Burn Injuries




Total

33

100.0



Fire/flame

3

9.1



Hot object

14

42.4



Hot liquid

11

33.3



Steam

1

3.0



Chemical

1

3.0



Other specified

2

6.1



Not recorded/unknown

1

3.0




Type of Poisoning




Total

35

100.0



Drug (excludes alcohol)

25

71.4



Alcohol

2

5.7



Chemical

3

8.6



Other specified

4

11.4



Not recorded/unknown

1

2.9




Other Specified Mechanisms




Total

132

100.0



Railway/streetcar

-----*

-----



Water transport

1

0.8



Air transport

-----

-----



Thrown or fallen from animal or

1

0.8




animal-drawn vehicle





Other transport

-----

-----



Inhalation/ingestion of food

2

1.5




(blocking airway)





Inhalation/ingestion of other objects

3

2.3




(blocking airway)





Hanging or strangulation

3

2.3



Suffocation

-----

-----



Entrapment in closed space

-----

-----



Venomous bite or sting

11

8.3



Human bite

12

9.1



Dog bite

24

18.2



Bite by animal other than dog

31

23.5



Sting

3

2.3



Fireworks explosion

-----

-----



Explosive blast

-----

-----



BB or pellet gunshot

2

1.5



Other firearm

-----

-----



Lightning

1

0.8



Electrical current

2

1.5



Radiation

1

0.8



Welding

1

0.8



Machinery

6

4.5



Exposure to excessive natural heat

2

1.5



Exposure to excessive natural cold

1

0.8



Sunlight

1

0.8



Natural disaster

-----

-----



Other specified

24

18.2


Figure 1. Average Kappa Statistic,* with 95% Confidence Interval, between Coders and the Gold Standard, by Selected Data Elements and Substudy Groups: CDC’s Short ICECI Pilot Study

* The kappa statistic measures the percent agreement beyond what can be expected by chance alone.

Values of kappa >75% are considered to be excellent, and values between 40% and 75% represent fair to good agreement.5