New Methodology for an Expert-Designed Map From International Classification of Diseases (ICD) to Abbreviated Injury Scale (AIS) 3+ Severity Injury

Objective: There has been a longstanding desire for a map to convert International Classification of Diseases (ICD) injury codes to Abbreviated Injury Scale (AIS) codes to reflect the severity of those diagnoses. The Association for the Advancement of Automotive Medicine (AAAM) was tasked by European Union representatives to create a categorical map classifying diagnoses codes as serious injury (Abbreviated Injury Scale [AIS] 3+), minor/moderate injury (AIS 1/2), or indeterminate. This study's objective was to map injury-related ICD-9-CM (clinical modification) and ICD-10-CM codes to these severity categories.

Methods: Approximately 19,000 ICD codes were mapped, including injuries from the following categories: amputations, blood vessel injury, burns, crushing injury, dislocations/sprains/strains, foreign body, fractures, internal organ, nerve/spinal cord injury, intracranial, laceration, open wounds, and superficial injury/contusion. Two parallel activities were completed to create the maps: (1) An in-person expert panel and (2) an electronic survey. The panel consisted of expert users of AIS and ICD from North America, the United Kingdom, and Australia. The panel met in person for 5 days, with follow-up virtual meetings to create and revise the maps. Additional qualitative data were documented to resolve potential discrepancies in mapping. The electronic survey was completed by 95 injury coding professionals from North America, Spain, Australia, and New Zealand over 12 weeks. ICD-to-AIS maps were created for: ICD-9-CM and ICD-10-CM. Both maps indicated whether the corresponding AIS 2005/Update 2008 severity score for each ICD code was AIS 3+, 1/2, or indeterminable. Though some ICD codes could be mapped to multiple AIS codes, the maximum severity of all potentially mapped injuries determined the final severity categorization.

Results: The in-person panel consisted of 13 experts, with 11 Certified AIS specialists (CAISS) with a median of 8 years and an average of 15 years of coding experience. Consensus was reached for AIS severity categorization for all injury-related ICD codes. There were 95 survey respondents, with a median of 8 years of injury coding experience. Approximately 15 survey responses were collected per ICD code. Results from the 2 activities were compared, and any discrepancies were resolved using additional qualitative and quantitative data from the in-person panel and survey results, respectively.

Conclusions: Robust maps of ICD-9-CM and ICD-10-CM injury codes to AIS severity categories (3+ versus <3) were successfully created from an in-person panel discussion and electronic survey. These maps provide a link between the common ICD diagnostic lexicons and the AIS severity coding system and are of value to injury researchers, public health scientists, and epidemiologists using large databases without available AIS coding.     

The evolution of socio-ecological systems: changing palm species management in the Colombian Amazon as an indicator of ecological and institutional change

We investigate natural resource governance in three indigenous communities in the Colombian Amazon. We base our analysis on an evolutionary governance model in which governance dimensions emerge as relevant through time. The less accessible of the communities represents earlier steps in governance evolution, while the more physically accessible is more integrated into the western scene. We observe how increased physical accessibility in a community brings in western governance models which hybridize with more traditional ones, influencing the couplings between the social and ecological systems. We zoom in on changing management of three commonly used palm species and illustrate how detailed studies of natural resource management contribute to understanding governance evolution. By comparing governance evolutions we were able to gain insights and improve our understanding on how natural resource management changes in communities transiting into western ways of living. In doing so we recognized points of rigidity and flexibility which might influence the social ecological systems capacity to adapt to changing conditions.     

Research priorities for managing the impacts and dependencies of business upon food,energy, water and the environment

Delivering access to sufficient food, energy and water resources to ensure human wellbeing is a major concern for governments worldwide. However, it is crucial to account for the ‘nexus’ of interactions between these natural resources and the consequent implications for human wellbeing. The private sector has a critical role in driving positive change towards more sustainable nexus management and could reap considerable benefits from collaboration with researchers to devise solutions to some of the foremost sustainability challenges of today. Yet opportunities are missed because the private sector is rarely involved in the formulation of deliverable research priorities. We convened senior research scientists and influential business leaders to collaboratively identify the top forty questions that, if answered, would best help companies understand and manage their food-energy-water-environment nexus dependencies and impacts. Codification of the top order nexus themes highlighted research priorities around development of pragmatic yet credible tools that allow businesses to incorporate nexus interactions into their decision-making; demonstration of the business case for more sustainable nexus management; identification of the most effective levers for behaviour change; and understanding incentives or circumstances that allow individuals and businesses to take a leadership stance. Greater investment in the complex but productive relations between the private sector and research community will create deeper and more meaningful collaboration and cooperation.     

Food justice youth development: using Photovoice to study urban school food systems*

How do youth learn through participation in efforts to study and change the school food system? Through our participatory youth action research (YPAR) project, we move beyond the “youth as consumer” frame to a food justice youth development (FJYD) approach. We track how a group of youth learned about food and the public policy process through their efforts to transform their own school food systems by conducting a participatory evaluation of farm-to-school efforts in collaboration with university and community partners. We used the Photovoice research method, placing cameras in the hands of young people so that they themselves could document and discuss their concerns and perspectives. The research was designed to gain insight about youths’ knowledge of food, health, and community food systems. Drawing upon the youth group’s insights, we build a framework for building critical consciousness through FJYD.