Injuries are a threat for the public health and one of the major causes of mortality and morbidity worldwide. The occurrence of various incidents, including car accidents, fights, occupational accidents, etc., can affect various aspects of life such as economic, social, comfort and security, general welfare and most importantly, the health of individuals (1). Based on the predictions of the World Health Organization (WHO), by 2020 injuries due to car accidents will be the 3rd cause of global mortality (2). Such accidents impose a major burden on both the government and the community. In order to reduce the undesired effects of such incidents, the design and performance of injury prevention strategies seems essential (3–6). On the other hand, in order to prevent injuries, access to accurate statistics in this respect is inevitable. This cannot be done except by using data on the causes of injuries that are correctly and thoroughly coded and implemented using the exact system of encryption and enforcement of the relevant rules (2,7,8). For encoding in the field of health, various international classification systems are available which each have a different application. International Classification of External Causes of Injury (ICECI) is an example; it is a multi-axis classification system with hierarchical codes. Since this system focuses on all details of the incident, the resulting data can be highly beneficial in injuries prevention (9,10).
Little research has been done on the prevention of injury by this coding system in other countries while only considering a special type of injury (such as the etiology of head traumas, burns, spinal injuries, etc.) (2,3,5).
To date, there is no study on the general etiology of a wide range of injuries in a special center. To the authors’ knowledge, no study has yet been done in Iran with this coding system on the external etiology of injuries. As a wide range of injuries and incidents can be identified in trauma hospitals, collecting the data related to the external cause of injury along with their classification and coding based on the ICECI can provide accurate statistics on these factors to health policy makers; this can result in better prevention strategies and identification of the deficiencies of the conventional classification system so as to be amended in future revisions.
The ICECI
Since 1980, a lot of criticism has been made regarding the ICD deficiencies such as lack of codes on the nature of injuries, and lack of logic and flexibility of this coding system for external causes of injuries. In April 1998, the WHO introduced an experimental system in the form of a list of tables as the International Classification of External Signs of Injury (ICECI). The last electronic version of this classification was published in July 2004 (1,11,12). This classification is used as a tool in the data management of external causes of injury. The aim for its design was to aid professionals and researchers in the statistical tracking and prevention of injury; it was developed to be applied in centers in which by using their recorded data the statistical reports of injuries could be provided.
This system has certain structural and conceptual characteristics that distinguishes it from the International Classification of Diseases (ICD). Conceptually, it is based on a clear and obvious model of events and incidents. Regarding its structure, it is a multi-axis, multipart classification system with hierarchical codes (13). This system is provided as an alphanumeric list and has two modules: the “core module” and “other modules”. The main part is completed for all types of injuries and includes 7 axes in the new revision as follows: 1. the role of human intent, 2. mechanism causing injury, 3. objects/substances producing injury, 4. place of occurrence, 5. activity when injured, 6. Use of alcohol and 7. use of (other) psycho-active drugs. The “other modules” include 5 items: violence, transfer, place, sports and occupation. The codes of this section are used when the codes in the core module do not represent the details of the event (13).