事故傷害外因註碼：國際疾病分類第九版與第十版之比較

External Cause of Injury Coding: A Comparison of the Ninth and Tenth Revisions of International Classification of Diseases

10.6288/TJPH2006-25-03-08

呂宗學(Tsung-Hsueh Lu)；江東亮(Tong-Liang Chiang)

死因 ； 死因統計 ； 國際疾病分類 ； 外因 ； 事故傷害防制 ； cause of death ； cause of death statistics ； International Classification of Disease ； external causes ； injury prevention

台灣公共衛生雜誌

25卷3期（2006 / 06 / 01）

242 - 251

繁體中文

目標：比較國際疾病分類第十版與第九版對於事故傷害外因註碼分類架構的差異，提供事故傷害死因統計使用者參考。方法：首先進行相關文獻回顧，接下來針對四個主要外因（陸上運輸、跌倒、溺水與中毒）及意圖與機轉矩陣進行第十版與第九版單一註碼之對應比較。結果：外因註碼在第九版還是補充分類，但是在第十版已經成為正式章節。第十版外因註碼三位碼有372個分類項，第九版只有192個分類項。第十版還增加了發生地碼與活動碼兩種選擇性第四位碼，提供更多環境與情況相關訊息。第十版陸上運輸事故之外因註碼採取矩陣分類架構，一個完整註碼要同時包括受傷者與對方的用路型態相關訊息（譬如行人、腳踏車、機車或汽車等）。第十版跌倒新增的註碼大多與老人有關（譬如被其他人搬運或扶持、輪椅或其他傢俱相關跌倒）。第九版溺水外因註碼重視活動相關訊息（譬如運動、娛樂或工作），第十版重視發生地與情況相關訊息（譬如澡盆、游泳池或大自然水中）。第十版還特別將溺水區分當時在（游泳池游泳）與跌入（游泳池）兩種訊息，有相當不同的防制意涵。中毒是第十版唯一分類項數目少於第九版的主要外因。相較於第九版，第十版的意圖與機轉矩陣分類架構較完整，每一意圖（意外、自殺、他殺或不確定）都有相關機轉（跌倒、溺水、中毒、撞擊或火燙傷等）的註碼。結論：就分類架構而言，第十版事故傷害外因註碼的確比第九版可以提供更多環境與情況相關訊息。可惜台灣第九版死因統計只註碼三位碼，因此許多與事故傷害防制相關的第四碼訊息無法獲得。台灣第十版將使用四位碼註碼，事故傷害外因註碼訊息可用性應該會提高。

Objective: To contrast the differences in the classification scheme of external cause of injury (ECI) coding between the Tenth and Ninth Revision of International Classification of Diseases (ICD-9 and ICD-10). Methods: We first reviewed the relevant references and then contrasted each code of four main ECI (i.e., land transport, falls, drowning and poisoning) and intent and mechanism matrix between ICD-9 and ICD-10. Results: The ECI was a supplement in ICD-9 and became a formal chapter in ICD-10. The number of 3-digit codes is 372 and 192 in ICD-10 and ICD-9, respectively. Two optional 4 digit codes (i.e., place of injury and activity) were added in ICD-10, which could provide more information on environmental events and circumstances. A matrix classification scheme was used for land transport coding in ICD-10, a complete code should include the road user type (e.g., pedestrian, bicycle, motorcycle or car) of both victim and counterpart. Most of the newly added codes in ICD-10 for falls are elderly-related (e.g., being carried or supported by other persons, involving wheelchair or other furniture). The 4th digit of drowning codes concerned more on activities (e.g., sports, recreations or work related) in ICD-9. Nevertheless, in ICD-10 more information was required regarding to place and circumstances (e.g., bath-tub, swimming pool or natural water). Besides, ICD-10 further classified drowning as 'while in' (e.g., swimming pool) or 'fall into' (e.g., swimming pool), which had different implication for injury prevention. Poisoning was the only main ECI of which the number of codes decreased from ICD-9 to ICD-10. Conclusions: With regard to the classification scheme, ECI in ICD-10 could provide more information on environmental events and circumstances compared with ICD-9. However, the 4th digit-related information was not available in Taiwan because only 3-digit codes were used for ICD-9. The 4-digit codes will be used in Taiwan for ICD-10, the ECI information will be increased.

1. Anderson RN, Minino AM, Fingerhut LA, Warner M, Heinen MA(2004).Deaths: Injuries, 2001. National Vital Statistics Reports; Vol. 52, No. 21.
2. Anderson RN, Minino AM, Hoyert DL, Rosenberg HM(2001).Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates. National Vital Statistics Reports; Vol. 49, No.2,Hyattsville, Maryland:
3. Baker SP(2000).Where have we been and where are we going with injury control.Mohan D, Tiwari G eds. Injury Prevention and Control.
4. Fingerhut L, Cox CS, Warner M(1998).International Comparative Analysis of Injury Mortality: Findings from the ICE on Injury Statistics.Advance Data from Vital and Health Statistics; No. 303,Hyattsville, MD:
5. Fingerhut LA, McLoughlin E(2001).Classifying and counting injury.Injury Control: A Guide to Research and Program Evaluation.
6. Harrison JE(2002).Injury classification: balancing continuity and utility.Inj Contr Safety Prom
7. Hofman K, Primack A, Keusch G, Hrynkow S(2000).Addressing the growing burden of trauma and injury in low-and middle-income countries.Am J Public Health.
8. Krug EG, Sharma GK, Lozano R(2000).The global burden of injuries.Am J Public Health.
9. Langley JD, Chalmers DJ(1999).Coding the circumstances of injury: ICD-10 a step forward or backwards.Inj Prev.
10. Lu TH(2003).Using ACME (Automatic Classification of Medical Entry) software to monitor and improve the quality of cause of death statistics.J Epidemiol Community Health.
11. Lu TH(2002).Changes in injury mortality by intent and mechanism in Taiwan, 1975-1998.Inj Prev.
12. McLaughlin E, Annest JL, Fingerhut LA(1997).Recommended framework for presenting injury mortality data.MMWR Recomm Rep
13. Mock C, Quansah R, Krishnan R, Arreola-Risa C, Rivara F(2004).Strengthening the prevention and care of injuries worldwide.Lancet.
14. Ohberg A, Lonnqvist J(1998).Suicides hidden among undetermined deaths.Acta Psychiatrica Scand.
15. Salib E(2004).Trends in suicide by drowning in the elderly in England and Wales 1979-2001.Int J Geriatr Psychiatry
16. WHO(2004).Holder Y, Peden M, Krug E, Lund J, Gururaj G, Kobusingye O eds. Geneva: WHO and Atlanta: Centers for Disease Control and Prevention
17. WHO(1977).International Statistical Classification of Diseases, Injuries, and Cause of Death, Ninth Revision,Geneva:
18. WHO(1992).International Statistical Classification of Diseases and Related Health Problems, Tenth Revision,Geneva:
19. 行政院衛生署(2005)。民國93年衛生統計(II)：生命統計，台北:
20. 呂宗學、石台平、李麗雪、賴華山、李孟智、周明智(1995)。國際疾病分類簡史與第十版簡介
21. 呂宗學、李孟智、周明智(1998)。事故傷害研究資料收集與分析的相關問題
22. 呂宗學、林進嘉(2005)。自殺防治的第三種策略－環境介入，7，106-14。

1. 劉士嘉、劉于琪、林正祥(2014)。臺灣事故傷害對潛在生命年數、工作年數及社會經濟損失影響探討。人口學刊，48，141-171。
2. 張自立、林慧敏、辛懷梓、王國華(2010)。環境安全與衛生通識課程對學生在認知及態度上之影響－以一所國立教育大學為例。臺北市立教育大學學報：教育類，41(2)，29-58。