NASA Technical Reports Server (NTRS) 20150001881: Astronaut Injury Surveillance Using the Barell Injury Diagnosis Matrix

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by  NASA Technical Reports Server (NTRS)

ASTRONAUT INJURY SURVEILLANCE USING THE
BARELL INJURY DIAGNOSIS MATRIX
J.D. Murray1, M.S. Laughlin2, D.L. Eudy3, M.L. Wear1, M. Van Baalen4
1Wyle, 1290 Hercules Drive, Houston, Texas 77058, [email protected],
2University of Houston, 3Enterprise Advisory Services, Inc., 4NASA Johnson Space Center
Figure 1. Total number of astronaut injuries, Level II body regions by injury site, 2004-2013.
INTRODUCTION
Astronautsperformphysicallydemandingtasksandrisk
incurring musculoskeletal injuries during both ground-
basedtrainingandspacemissions. Theappearanceof
increasedinjuryrateshasbeenattributedtonumerous
factors, including an aging astronaut corps, increased
Weightless Environment Training Facility (WETF) and
Neutral Buoyancy Laboratory (NBL) training, and
improved clinical operations that promote injury
reporting. Over the years, NASA has implemented
techniquestohelpdecreasethenumberofinjuries,but
therehasnotbeenasystem-widesurveillanceprogram
totrackinjuryrates.
The Barell Injury Diagnosis Matrix is an injury
classificationsystemthatmayserveasthefoundation
of an injury surveillance system. The Matrix was
introducedin2001asapotentialstandardizedmethod
of classifying body region by nature of injury.1
Diagnoses are coded using the International
Classification of Diseases, Ninth Revision, Clinical
Modification(ICD-9-CM)codingsystem. Thepurposeof
thisstudyistoassesstheusefulnessandcomplexityof
theBarell Injury Diagnosis Matrixto classifyand track
musculoskeletalinjuriesamongNASAastronauts.
MATERIALS & METHODS
A Certified Professional Coder through the American
AcademyofProfessionalCodersreviewedtheICD-9-CM
codes used in the 2005 Barell Injury Diagnosis Matrix
update to ensure it contained a comprehensive set of
LIMITATIONS
injury codes and to verify the inclusion of diagnoses Figure 2. Number of Level II body injuries by year.
unique to the environment of space travel. No TheEMRiscurrentlythebestsourceforastronautmedicaldata;
additional codes were recommended. The Flight however,itseffectivenessasasurveillancesystemdatasourceis
Medicine Clinic’s Electronic Medical Record (EMR) was limitedbyinaccuraciesofbothmedicaldataandICD-9-CMcodes
queriedforallICD-9-CMcodescontainedintheMatrix. aswellasdelayswithdocumentapprovals. Theeffectivenessof
Resultswerefilteredtoincludediagnosesfrom2004to the Matrix is hindered by its lack of Current Procedural
2013 for new medical events among NASA astronauts Terminology® (CPT) codes, which communicate information
whowereactiveintheastronautcorpsatthetimeof about medical services and procedures received. Injuries may
diagnosis. Injuries were categorized by body region bedocumentedbyICD-9-CMand/orCPTcodes,whichmayresult
and nature of injury according to the Matrix. To inmissedcases. Furthermore,theMatrixgivesnoindicationof
preventinflatingthetotalnumberofinjuries,multiple external cause or severity. This would give equal weight to a
ICD-9-CM codes per person per body region in a simpleinjurysuchasanabrasionandamoresevereinjurysuch
calendaryearwerecountedasasingleinjury. asanamputation,forexample.
RESULTS CONCLUSIONS
The Matrix classifies body regions using three levels. TheBarellInjuryDiagnosisMatrixmaybeasuitablecandidateon
Level I: 36 small, well-defined categories; Level II: 9 which to base an astronaut injury surveillance system when
mid-sizecategories;LevelIII:5broadcategories. Using there are no other viable options that use ICD-10 or SNOMED
theLevelIIcategories,279injurieswereclassifiedinto coding systems. However, its limitations allow room for
7of9bodyregions. ‘SprainsandStrains’(40.5%)was improvement. TheMatrixislikelytounderestimatethenumber
themostcommoninjurytype,and‘UpperExtremities’ REFERENCE of injuries, which may also differ from the number of injuries
(30.8%) was the most common injury site. (Figure 1) 1."TheBarellInjuryDiagnosisMatrix,ClassificationbyBody reportedbyotherresearchprojects,becauseofdifferentinjury
‘System-wide&LateEffects’(9%)includeseventssuch RegionandNatureoftheInjury." CentersforDiseaseControl definitions and different approaches to identifying cases. This
as motion sickness and toxic effects of venom. From and Prevention, 24 June 2010. Website: approach is intended to be a high-level summary capable of
2004 to 2013, the number of injuries per year ranged www.cdc.gov/nchs/injury/ice/barell_matrix.htm. Retrieved identifying trends over time. It does not take the place of
from15to35withanaverageof27.9. (Figure2) 01Sept2014. individual research projects with their own injury definitions,
specificanatomicalsites,andmechanismsofinjury.
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