Concept: Fractures: Case Definitions Using Administrative Data

Introduction

This concept provides information on fracture definitions that are developed from administrative health data. This concept identifies the data sources in the MCHP Data Repository used to develop the fracture definitions, and lists different research projects that have developed fracture case definitions. For each research project, the types of fractures are identified, along with the ICD diagnosis codes and tariff codes used to define each fracture.

The final section of the concept lists diagnosis codes for extreme trauma, which are usually excluded from fracture definitions in osteoporosis-related research. These cases are excluded because fractures caused by extreme trauma are not necessarily due to weakened bones.

Data Sources

The two data sources in the MCHP Data Repository that are used to define fractures for research include:


• Hospital Abstracts data; and the
  
• Medical Services (Physician Claims) data
  
  Note:
  
  • The hospital data contains 5-digit ICD-9-CM diagnosis codes (for data up to 2003/04) and 7-digit ICD-10-CA diagnosis codes (from 2004/05 forward).
    
  • The Medical Services / Physician Claims data contains one, 3-digit ICD-9-CM diagnosis code and one, 4-digit physician tariff codes in each record.
    
    NOTE: In December 2018, a 5-digit diagnosis code variable was added to the Medical Services data. If recorded, the first 3-digits of both the 3-digit and 5-digit diagnosis code variables will match exactly. The 5-digit diagnosis code variable applies to records from 2015/16 forward.
    
    NOTE: Tariff codes can change over time and should be reviewed and updated if necessary, prior to the start of any research.

Fracture Definitions

The following is a list of research that defines different types of fractures, and the ICD-9-CM / ICD-10-CA diagnoses codes and conditions used to define each type of fracture from the hospital or medical services data. The research includes work done with the Bone Mineral Density Program and at MCHP.

Different definitions are used in different types of research.

1. Bone Mineral Density Research

The following fracture definitions were developed for use in research involving the Bone Mineral Density (BMD) Program. The definitions are taken from the SAS code available in the SAS code and formats section below (internal access only). For more information on the BMD program, please see the Establishing a regional bone density program: Lessons from the Manitoba experience reference below.

In addition to the ICD codes from the hospital abstracts and medical services data, two of the fracture definitions require specific tariff codes that are available in the medical services data.


• Vertebral (Spine)
  
  • one or more hospitalizations with the most responsible diagnosis code in the range of 805.2-805.5 (ICD-9-CM) or S22.0, S22.1, or S32.0 (ICD-10-CA); OR
    
  • one physician visit with a diagnosis code of 805 (ICD-9-CM)
  
  
• Humerus
  
  • one or more hospitalizations with the most responsible diagnosis code of 812.0 or 812.1 (ICD-9-CM) or S42.2 (ICD-10-CA); OR
    
  • two physician visits within 3 months with a diagnosis code of 812 (ICD-9-CM)
  
  
• Wrist
  
  • one or more hospitalizations with the most responsible diagnosis code of 813 (ICD-9-CM) or S52 (ICD-10-CA); OR
    
  • two physician visits within 3 months with a diagnosis code of 813 (ICD-9-CM)
  
  
• Hip
  
  • one or more hospitalizations with the most responsible diagnosis code of 820 (ICD-9-CM) or in the range of S72.0-S72.2 (ICD-10-CA)
  
  
• Non-Hip Femoral (Open)
  
  • one or more hospitalizations with the most responsible diagnosis code of 821.1 or 821.3 (ICD-9-CM), or S72.201 or S72.301 (ICD-10-CA); PLUS
    
  • a physician tariff code during the hospital admission for shaft fracture reduction or fixation, open or closed - tariff codes: 0881, 0882, 0883
  
  
• Non-Hip Femoral (Closed)
  
  • one or more hospitalizations with the most responsible diagnosis code of 821.0 or 821.2 (ICD-9-CM) or S72.200 or S72.300 (ICD-10-CA); PLUS
    
  • a physician tariff code during the hospital admission for shaft fracture reduction or fixation, open or closed - tariff codes: 0881, 0882, 0883
  
  
• Peri-Prosthetic Femoral
  
  • one or more hospitalizations with a combination of any diagnosis code in the range of 820-821, PLUS 996.4 (complication of orthopedic device) - (ICD-9-CM) or a combination of any diagnosis code of S72.x, PLUS T84.03 or T84.13 or M96.6 (complication of orthopedic device) - (ICD-10-CA).
    
    NOTE:
    • These types of fractures take priority over other hip / femoral fractures (specific condition for BMD research).
      
    • Pre-existing prosthesis can be identified by the codes E878.1 (ICD-9-CM) or Y83.1 (ICD-10-CA)
  
  
• Pelvic
  
  • one or more hospitalizations with the most responsible diagnosis code of 808 (ICD-9-CM) or S32.1 or in the range S32.3-S32.5 (ICD-10-CA); OR
    
  • two physician visits within 3 months with a diagnosis code 808 (ICD-9-CM)
  
  
• Ankle
  
  • one or more hospitalizations with the most responsible diagnosis code of 824 (ICD-9-CM) or S82.5 or S82.6 (ICD-10-CA); OR
    
  • two physician visits within 3 months with a diagnosis code 824 (ICD-9-CM)
  
  
• Other (non-skull / facial)
  
  • one or more hospitalizations with the most responsible diagnosis code of 807, 810, 811, or in the range 822-823 (ICD-9-CM) or in the ranges: S22.2-S22.5, S22.8-S22.9, S42.0-S42.1, S42.3-S42.4, S82.0-S82.4 or S82.7-S82.9 (ICD-10-CA); OR
    
  • two physician visit within 3 months with a diagnosis code of 807, 810, 811, or in the range 822-823 (ICD-9-CM)

2. Lix et al. (2012)

In Lix et al. (2012), they investigated 35 different case definitions for fractures of the hip, wrist, humerus, and clinical vertebrae using diagnoses and service codes found in hospital and medical services (physician billing) data from Manitoba. They compared estimates from administrative data with clinically validated data from the Canadian Multicentre Osteoporosis Study, and tested for differences in incidence estimates using the 35 case definitions.

The 35 case definitions were selected based on a review of publications, clinical expertise and the author's experience with chronic diseases. Table 1 in the publication lists the 35 different case definitions selected. For more information, please read: Osteoporosis-related fracture case definitions for population-based administrative data by Lix et al. (2012).

3. Martens et al. (2015)

In the MCHP deliverable The Cost of Smoking: A Manitoba Study deliverable by Martens et al. (2015), they calculated the weighted crude prevalence of osteoporosis-related fractures for survey respondents aged 50 and older as the percentage of people who suffered one or more osteoporosis-related fractures in the five years before their survey date. Fracture case definitions were based on the definitions investigated in the publication Osteoporosis-related fracture case definitions for population-based administrative data by Lix et al. (2012) - see number 2 above.

The four fracture case definitions used in Martens et al. (2015) were:


• hip fracture
  
  • one or more hospitalizations with a most responsible diagnosis code of 820 (ICD-9-CM) or S72.0-S72.2 (ICD-10-CA)
  
  
• wrist fracture
  
  • one or more hospitalizations with a diagnosis code of 813 (ICD-9-CM) or S52 (ICD-10-CA); OR
    
  • one or more physician visits with a diagnosis code of 813 (ICD-9-CM) in combination with physician tariff code for fracture repair (0807, 0810, 0811, 0821, 1851, 1854, 1856, or 1860)
  
  
• humerus fracture
  
  • one or more hospitalizations with a most responsible diagnosis code of 812 (ICD-9-CM) or S42.2 (ICD-10-CA); OR
    
  • one or more physician visits with a diagnosis code of 812 (ICD-9-CM)
  
  
• vertebral (spine) fracture
  
  • one or more hospitalizations with a diagnosis code of 805 (ICD-9-CM) or S22.0, S22.1, S32.0 (ICD-10-CA); OR
    
  • one or more physician visits with a diagnosis code of 805 (ICD-9-CM)

For more information on the prevalence rates of osteoporosis-related fractures from The Cost of Smoking: A Manitoba Study deliverable, see Table 4.8 Chronic Diseases of Estimated-Population-Based Sample* at Time of Survey by Smoking Status Categories in Martens et al. (2015). NOTE: For rates, the denominator includes all survey respondents aged 50+.

4. Lix et al. (2016)

In the Cancer Data Linkage in Manitoba: Expanding the Infrastructure for Research deliverable by Lix et al. (2016) the following fracture case definitions were developed based on information in an unpublished Public Health Agency of Canada (PHAC) document, titled Framework for National Surveillance on Osteoporosis and Osteoporosis-related Fractures using Provincial/Territorial Administrative Data, July 2014; O'Donnell, S; Canadian Chronic Disease Surveillance System (CCDSS) Osteoporosis Working Group:


• hip fracture
  
  • one or more hospitalizations with a most responsible diagnosis code of 820 (ICD-9-CM) or S72.0-S72.2 (ICD-10-CA), with a 6 month fracture-free period prior to cancer dx
  
  
• humerus fracture
  
  • one or more hospitalizations with a most responsible diagnosis code of 812 (ICD-9-CM) or S42 (ICD-10-CA), with a 6 month fracture-free period prior to cancer dx; OR
    
  • 2 or more physician visits with a diagnosis code of 812 (ICD-9-CM) within 3 months with a 6 month fracture-free period prior to cancer dx.
  
  
• spine (vertebral) fracture
  
  • one or more hospitalizations with a most responsible diagnosis code of 805.2-805.5 (ICD-9-CM) or S22.0, S22.1, S32.0 (ICD-10-CA) with a 6 month fracture-free period prior to cancer dx; OR
    
  • one or more physician visits with a diagnosis code of 805 (ICD-9-CM) with a 6 month fracture-free period prior to cancer dx.
  
  
• wrist fracture
  
  • one or more hospitalizations with a most responsible diagnosis code of 813 (ICD-9-CM) or S52 (ICD-10-CA) with a 6 month fracture-free period prior to cancer dx; OR
    
  • two or more physician visits with a diagnosis code of wrist fracture (first diagnosis must be coded 813 (ICD-9-CM) and the second diagnosis coded can be 813 or 814 (ICD-9-CM), within 3 months with a 6 month fracture-free period prior to cancer dx.

Other conditions/restrictions that were applied to these fracture definitions included:


• age 40+ for all fractures;
  
• use of hospital admission date for fracture date, not hospital separation/discharge date;
  
• for hospital separation data, all hospitalizations were included (i.e.: not restricted to inpatient stays only) and all fracture diagnoses were restricted to those found in the most responsible diagnosis field.
  
• for physician visits, this includes visits to all physicians (e.g.: GPs and specialists), but excludes radiologists and lab visits. In addition, this is restricted to ambulatory visits only (prefix=7).

Trauma Indicators

Fractures caused by extreme trauma are typically excluded in osteoporosis-related research because the fracture may not be caused by weakened bones. In MCHP research, extreme trauma is indicated by the following ICD-9-CM and ICD-10-CA codes in the hospital data:



Category of Injury	ICD-9-CM Codes	ICD-10-CA Codes
Transport accidents	E800-E848	V01-V99
Falls from significant heights	E881-E884	W11-W17
Exposure to inanimate mechanical forces	E916-E923, E928.1, E928.2	W20-W49
Exposure to electric current, radiation and extreme ambient air temperature and pressure	E900-E902, E925-E926	W85-W99
Contact with heat and hot substances	E924	X10-X19
Exposure to forces of nature	E908-E909	X34-X39
Overexertion, travel and privation	E903, E904.1-E904.9, E927, E928.0	X50-X57
Accidental exposure to other and unspecified factors	E887, E928.8, E928.9	X58-X59