E Codes

From Summer 1995
Volume II, Number 2

One of the keys to an effective traffic safety or injury prevention program is a clear understanding of the injury problem. Important elements of this understanding concern the number of injuries that occur, their nature and severity (e.g., whether the injuries are scrapes and minor lacerations, fractures and concussions, or head and spinal cord injuries), who is being injured, how these injuries occur, and where they occur. Traffic safety and injury prevention professionals can use this information to identify and prioritize injury problems, and target prevention programs. Program managers can decide, for example, whether they should focus their limited resources on a campaign to reduce pedestrian injuries among the elderly or bicycle injuries to children. More detailed information on precisely how bicycle injuries are occurring in a community can play a large role in deciding whether efforts should be made to increase bicycle helmet use among children or if it is more important to create bicycle paths that separate bicycles from motor vehicles.

Police reports--an important source of information about the circumstances surrounding traffic injuries--often lack detailed information about the injuries themselves. The information on injuries that is contained in these reports is often lost when the records are abstracted for computerization. Some traffic-related injuries, especially those that occur to bicyclists, are never reported to police.

Medical and emergency medical services data can provide more information about the injuries themselves. What is often missing from these sources is information about the causes and circumstances of injuries: the "how." It is difficult to design programs that will effectively prevent injuries if the causes of these injuries are unknown. Fortunately, there is a relatively inexpensive method of quickly and efficiently recording information on the causes of injury in existing data sets (such as ambulance run sheets or hospital discharge data). These External Cause of Injury codes (commonly called E codes) were developed by the World Health Organization (WHO) as a supplemental code for use with the International Classification of Diseases (ICD). These four-digit E codes provide a systematic way to classify diagnostic information that doctors, nurses, and other health care providers have entered into the medical record. They are standardized internationally; allow consistent comparisons of data among communities, states, and countries (or across time for purposes of evaluation studies); and are easily used in computerized data systems. If E codes are included in hospital records, the medical and financial consequences of particular types of motor vehicle injuries can be examined.

E codes provide information about both the event during which the injury took place and the individuals who were injured. For example, E codes can record whether the individual injured was a passenger in a motor vehicle that collided with another motor vehicle (E813.1) or the driver of a motor vehicle that collided with a train (E810.0). When combined with other information in the medical record (especially N codes, which define the medical nature of an injury), E codes can tell us a great deal about the types of events that produce injuries and the types of injuries they produce.

E codes are mandatory on death records for all persons whose deaths are injury related.

They are less frequently included in other important injury data sources, such as hospital discharge data, emergency room records, and ambulance run reports. E codes are not used for reimbursement, so they are frequently dropped in abstracting records for computer entry. But E codes are not research trivia. They can create a picture of the specific circumstances of an injury which, in conjunction with other data, become the foundation for many injury prevention activities to make communities safe. As managed care and capitation grow, injury prevention will take on a new importance for hospitals as they realize the cost-effectiveness of prevention programs. Traffic safety and emergency medical service professionals are also finding E codes to be a valuable resource for targeting and evaluating programs. The sidebar on E Codes in Arizona demonstrates how E codes were used in one state to better understand the head and spinal cord injury problem and implement measures to reduce these injuries.

Consistent use of E codes in hospital discharge data, emergency department records, and ambulance run sheets would provide an extremely valuable resource for the study of and prevention of injuries. Traffic safety and public health professionals can advocate for E codes by showing administrators and medical personnel that E codes can lead to more effective injury prevention efforts. They can also work toward state regulations requiring the inclusion of E codes in data sets. Sixteen states require that E codes be included in discharge or billing data.

A complete list of E codes is included in The International Classification of Diseases, Ninth Revision, Clinical Modification, Fourth Edition, DHHS (publication number 91-1260). It is also available on CD-ROM (stock number 017-022-01268-5) for $18. Both the printed copy and the CD-ROM are available from the United States Government Printing Office at (202) 512-1800. Another useful resource is the ICD-9CM Easy Coder by Paul Tanaka, which is published by Unicor Medical, Inc., 4160 Carmichael Road, Montgomery, AL 36106. Phone (205) 260-8150.

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Other Information Available On-line about E codes:
E Codes Introduction
E Codes: The Missing Link in Injury Prevention
Commonly Asked Questions About E Codes
E Codes in Arizona (A case study originally published in Building Bridges)
Building Bridges Building Bridges Home Page

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