Qualitative assessment of cause-of-injury coding in US military hospitals:NATO Standardization Agreement (STANAG) 2050

Background: Accurate injury cause data are essential for injury prevention research. U.S. military hospitals, unlike civilian hospitals, use the NATO STANAG system for cause-of-injury coding. Reported deficiencies in civilian injury cause data suggested a need to specifically evaluate the STANAG. Methods: The Total Army Injury and Health Outcomes Database (TAIHOD) was us ed to evaluate worldwide Army injury hospitalizations, especially STANAG Tr auma, Injury, and Place of Occurrence coding. We conducted a review of hosp ital procedures at Tripler Army Medical Center (TAMG) including injury caus e and intent coding, potential crossover between acute injuries and musculo skeletal conditions, and data for certain hospital patients who are not tru e admissions, We also evaluated the use of free-text injury comment fields in three hospitals. Results: Army-wide review of injury records coding revealed full compliance with cause coding, although nonspecific codes appeared to be overused, A s mall but intensive single hospital records review revealed relatively poor intent coding but good activity and cause coding, Data on specific injury h istory were present on most acute injury records and 75% of musculoskeletal conditions. Place of Occurrence coding, although inherently nonspecific, w as over 80% accurate. Review of text fields produced additional details of the injuries in over 80% of cases. Conclusions: STANAG intent coding specificity was poor, while coding of cau se of injury was at least comparable to civilian systems. The strengths of military hospital data systems are an exceptionally high compliance with in jury cause coding, the availability of fi ee text, and capture of all popul ation hospital records without regard to work-relatedness, Simple changes i n procedures could greatly improve data quality, (C) 2000 American Journal of Preventive Medicine.