Injury Hospitalization Dataset Details

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The Colorado Health and Hospital Association (CHHA) compiles hospital discharge data from all acute care and many specialty hospitals in Colorado. This database includes demographic, diagnostic, procedural, payment and length of stay information on all inpatient admissions. Injury hospitalizations are identified using specific codes from the International Classification of Diseases, Version 9, Clinical Modification (ICD-9-CM). For more information regarding the Colorado Health and Hospital Association and the hospital discharge dataset, please visit the CHHA website at www.cha.com.

Clarification on Injury Hospitalization Data

Number of injury hospitalizations

Injury hospitalizations refer to the number of acute care hospital discharge records with at least one of the following ICD-9-CM diagnosis codes mentioned as one of the first six diagnoses:

N800-N904
N910-N929
N940-N957
N959
N960-N989
N990-N992
N994, N995.5, N995.8

Records from rehabilitation facilities or with a rehabilitation diagnosis code (V57) are excluded. All transfers, readmissions or multiple records of the same injury event are also excluded.

Definition of the injury mechanism and associated ICD-9 E-code

Mechanism of injury (i.e., the activities or circumstances that led to the hospitalization) is determined by the E-codes listed in the CHHA hospital discharge data set. The External cause of injury codes (E-codes) are a subset of the International Classification of Diseases, Ninth Revision, used to classify the environmental events, circumstances, and conditions that are the cause of injury, poisoning, or other adverse effects. For the complete list of injury mechanisms and their associated ICD-9 E-codes please see:

Definitions of Injury mechanism and associated ICD-9 codes

Mechanism of Injury	ICD-9 E-code
Hospitalizations with mechanism mentioned	E800-848, E850-869, E880-928 E950-958, E960-968, E970-976 E980-988
Total unintentional injuries	E800-848, E850-869, E880-928
Transportation	E800-848
Railway	E800-807
Railway employee/passenger	E800-807 (.0-.1)
Pedestrian	E800-807 (.2)
Pedal cyclist	E800-807 (.3)
Motor vehicle traffic	E810-819
Motor vehicle occupant	E810-819 (.0-.1, .9)
Driver	E810-819 (.0)
Passenger	E810-819 (.1)
Motor cyclist	E810-819 (.2-.3)
Driver	E810-819 (.2)
Passenger	E810-819 (.3)
Pedal cyclist	E810-819 (.6)
Pedestrian	E810-819 (.7)
Rider of animal or occupant of       animal-drawn vehicle	E810-819 (.5)
Motor vehicle non-traffic	E820-825
Motor vehicle occupant	E820-825 (.0-.1, .9)
Driver	E820-825 (.0)
Passenger	E820-825 (.1)
Motor cyclist	E820-825 (.2, .3)
Driver	E820-825 (.2)
Passenger	E820-825 (.3)
Pedal cyclist	E820-825 (.6)
Pedestrian	E820-825 (.7)
Snowmobile driver/passenger	E820 (.0-.1, .9)
Rider of animal or occupant of       animal-drawn vehicle	E820-825 (.5)
Other road vehicle crashes	E826-829
Pedestrian	E826-829 (.0)
Pedal cyclist	E826-829 (.1)
Rider of animal or occupant of       animal-drawn vehicle	E826-829 (.2-.3)
Water transport	E830-838
Occupant of watercraft	E830-838 (.0-.3)
Water-skier/swimmer	E830-838 (.4-.5)
Air transport	E840-845
Occupant of aircraft/spacecraft	E840-845 (.0-.7)
Other transport related	E846-848
Drowning	E830, E832, E910
Boat-related	E830, E832
Non-boat	E910
Recreational	E910 (.0-.2)
Bathtub	E910.4
Poisoning	E850-869
Heroin/Opiates/Narcotics	E850 (.0-.2)
Aspirin	E850.3
Barbiturates	E851
Tranquilizers	E853
Other psychotropic agents	E854
Alcohol	E860
Carbon monoxide	E867-868
Falls	E880-888
From stairs/steps	E880
From ladders/scaffolding	E881
From building/structure	E882
Into a swimming pool	E883.0
Into a well/manhole/hole	E883 (.1-.2, .9)
From playground equipment	E884.0
From cliff	E884.1
From chair/furniture (not bed)	E884 (.2, .5)
From wheelchair	E884.3
From bed	E884.4
From commode	E884.6
On same level, by slipping, tripping,     or stumbling	E885
Roller skates, in-line skates (2001 only)	E885.1
Skates board (2001 only)	E885.2
Skis (2001 only)	E885.3
Snowboard (2001 only)	E885.4
On same level by collision, pushing,    shoving, by or with other person    (Including in sports)	E886
Other unspecified fall	E888
Fire/Burn	E890-899, E924
Fire/Burn due to flames	E890-899
House fires	E890
From ignition of clothing	E893
Scalds/Caustic substances    /Hot objects	E924
Natural/Environmental	E900-909
Excessive cold (weather)	E901.0
Hunger, thirst, exposure, and neglect	E904
Venomous snakes/lizards	E905.0
Venomous spiders	E905.1
Hornet, wasps, bees	E905.3
Dog bite	E906.0
Cat/rodent (except rat) bite	E906.3
Other animal-related Injury,    not being ridden	E906.8
Lightning	E907
Other unintentional	E911-923, E925-928
Aspiration/Suffocation	E911-913
Foreign body	E914-915
Struck by falling object	E916
Striking against or by objects    /persons (Including in sports)	E917
Caught in or between objects	E918
Machinery	E919
Agricultural machines	E919.0
Lifting machines	E919.2
Woodworking/forming machines	E919.4
Cutting and piercing instruments	E920
Powered lawn mower	E920.0
Powered hand tools	E920.1
Knives, swords, daggers	E920.3
Other hand tools/implements	E920 (.4-.5, .8-.9)
Firearms/Airguns	E922
Handgun	E922.0
Shotgun	E922.1
Rifle	E922.2
Airgun	E922.4
Unspecified	E922.9
Fireworks	E923.0
Electric current	E925
Overexertion	E927
Other unspecified injury	E928.9
Total Intentional Injuries	E950-958, E960-968, E970-976
Suicide/Self-inflicted	E950-958
By solid/liquid drug overdose	E950
By gas	E951-952
By motor vehicle exhaust	E952.0
By hanging/suffocation	E953
By firearms/airguns	E955 (.0-.4, .6)
Handgun	E955.0
Shotgun	E955.1
Rifle	E955.2
Airgun	E955.6
Unspecified	E955.4
By cutting/piercing	E956
By jumping from high place	E957
By other means	E958
Assault	E960-968
Unarmed fight/brawl	E960.0
By firearms	E965 (.0-.4)
Handgun	E965.0
Shotgun	E965.1
Rifle	E965.2
Unspecified	E965.4
By stabbing	E966
Child/adult abuse	E967
By other or unspecified means	E968
Legal intervention	E970-976
By firearms
Total Undetermined Intent	E980-988
Poisoning by solids/liquids	E980
Poisoning by gases	E981-982
Hanging/strangulation/suffocation/drowning	E983-984
By firearm	E985 (.0-.4)
Cutting/piercing	E986
Other means	E987-988
Total firearm-related	E922 (.0-.3, .8-.9), E955 (.0-.4) E965 (.0-.4), E970, E985 (.0-.4)
Unintentional	E922 (.0-.3, .8-.9)
Suicide	E955 (.0-.4)
Assault	E965 (.0-.4)
Legal intervention	E970
Undetermined intent	E985 (.0-.4)
Prepared by Injury Epidemiology Program, Colorado Department of Public Health and Environment.

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Multiple causes for injury hospitalizations

Some records in the hospital discharge data set have been assigned more than one ICD-9-CM external cause of injury code (E-code). Hospitalizations with more than one E-code may be counted in more than one injury mechanism category.

Year of data

The year is defined as the year the patient was discharged from the hospital.

Race/ethnicity data

Race/ethnicity information frequently is missing from the hospital discharge dataset. For this reason, injury hospitalizations by race/ethnicity are not presented here.

Residence and occurrence data

Residence data, unless otherwise noted, are for events that happened to individuals who were reported as being residents of Colorado. Occurrence data are for events that took place in Colorado regardless of residence of the injured person. Statistics with occurrence data will be designated "Colorado Occurrences" in the title. All the rates presented in the reports are based on hospitalizations involving Colorado residents. County or region specific data include only hospitalizations involving residents of those counties or regions.

Traumatic brain injury

Traumatic brain injuries include concussions, skull fractures, and intracranial injuries resulting from an external impact or forces of acceleration or deceleration. In this query system, traumatic brain injury related hospitalizations are defined as discharge records with any mention of ICD-9-CM codes of 800, 801, 803, 804, 850-854, or 959.01 within the first six diagnoses.

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Intent of injury

Intentional injuries, such as homicide and suicide, involve acts in which there is intent to kill or harm. Unintentional injuries involve acts in which there is no intent to harm; these injuries are sometimes labeled as "accidental". In some cases, the intentionality has not been determined. These injuries are categorized as "undetermined intent."

Legal intervention

This category includes injuries that were inflicted in the course of performing legal law enforcement actions. In this report, as in National Vital Statistics Reports, injuries due to legal intervention are grouped with homicide and assault.

Regional Emergency and Trauma Advisory Councils (RETAC)

Colorado has eleven emergency medical and trauma regions. Each region consists five or more counties that participate through a local advisory council. Each RETAC has a coordinator that provides support and services to the member counties. The counties included in each RETAC are:

1. Northwest RETAC: Garfield, Mesa, Moffat, Rio Blanco and Routt
2. Western: Delta, Gunnison, Hinsdale, Montrose, Ouray and San Miguel
3. Southwest: Archuleta, Dolores, La Plata, Montezuma, San Juan
4. Foothills: Boulder, Clear Creek, Gilpin, Grand and Jefferson
5. Central Mountain: Chaffee, Eagle, Lake, Park, Pitkin and Summit
6. San Luis Valley: Alamosa, Conejos, Constilla, Mineral, Rio Grande and Saguache
7. Northeast: Jackson, Larimer, Logan, Morgan, Phillips, Sedgwick, Washington, Weld and Yuma
8. Mile High: Adams, Arapahoe, Denver, Douglas and Elbert
9. Plains to Peaks: Cheyenne, El Paso, Kit Carson, Lincoln and Teller
10. Southern: Custer, Fremont, Huerfano, Las Animas and Pueblo
11. Southeast: Baca, Bent, Crowley, Kiowa, Otero and Prowers.

Small numbers

Many Colorado counties have small populations and therefore few injury events. Interpretation of statistics in such areas may be difficult, since analysis of year-to-year changes or comparisons with other areas are hampered by a tendency for rates and percentages to fluctuate.

Combining multiple years of data provides a more reliable indicator of what is "true" for an area. Combining county data into regional data for places with small numbers of events and small populations is another way of improving the general usefulness of the data. The results of any search returning fewer than three events will be suppressed.

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Confidence intervals

Confidence intervals are statistics used to describe the possible margin of error in a reported rate. As discussed above, the number of events, and therefore the rate, can vary from year to year. Calculating a confidence interval provides a better indication of what the "true" rate might be. A 95 percent confidence interval indicates that the "true" rate will be a value between the lower and upper limits of the confidence interval 95 percent of the time. If the number/rate varies greatly from year to year, the confidence interval will be very large. If the number/rate is fairly stable, the confidence interval will be small. Confidence intervals can be used for statistical comparisons of rates in different populations and over different periods.

Crude hospitalization rate

The number of hospitalizations per a specified number of population (e.g., per 100,000). Crude rates are not adjusted for differences in demographic distributions among populations, such as age distributions.

Age-adjustment of rates

Some query results present age-adjusted hospitalization rates. All age-adjusted rates are per 100,000 Colorado population. Rates are adjusted to the U.S. standard population using the direct method applied to 10-year age groups. Age adjustment, using the direct method, involves the application of age-specific rates in a population of interest to a standardized age distribution in order to eliminate differences in observed rates that result from age differences in population composition. This adjustment is usually done when comparing two or more populations at one point in time or one population at two or more points in time.
In comparing age-adjusted rates from different sources, it is important to be certain that the same methods and standard populations were used. At this site, users will be able to select the 1940, the 1970, or the 2000 population to allow comparability to other data sets adjusted to these various standards.

Data quality

Data generally are presented as coded on hospital discharge dataset records. As with all large, complex data sets, completeness and accuracy of reporting may vary. Some attempts at verification of information by review of a sample of medical records has been done, particularly with patients who sustained a traumatic brain injury; however, in most instances, the diagnoses and mechanism of injuries are as coded in the electronic data files, without independent verification.

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