Recreational Boating Incidents v1 | Knowledge Repository

Query purpose:

The objective is to identify visits that likely reflected recreational boating incidents that should have been reported via federal regulation (33 CFR 174.121) to the United States Coast Guard as part of the National Recreational Boating Safety Program. More information on recreational boating incident reporting and statistics can be found on this website: https://uscgboating.org/statistics/accident_statistics.php

Definition description:

Recreational boating incidents or injuries that occurred on a boat but not in transporting the boat or on a commercial boat (i.e., ferry boat or cruise ship). Recreational watercraft activities that occur on boats were included: wakeboarding, waterskiing, tubing. Other recreational watercraft were included: jet skis (including brand names like Sea-Doo and WaveRunner), kayaks, canoes, and rafts. Subsequent encounters or sequalae of injury were negated in this query.

How it was developed: The CDC National Syndromic Surveillance Program (NSSP) team and subject matter experts from the U.S. Coast Guard (USCG) worked with six jurisdictions (FL, ND, MI, TN, WA, and WI) to pilot a v1 definition using visit data from May – October 2021.

1. The CDC team evaluated the diagnosis codes (International Classification of Diseases, 10th Revision (ICD-10-CM)) in a boating incidents query created by WA Department of Health (DOH), assessing which codes were necessary for identifying recreational boating incidents, or should be removed or recategorized from inclusion to exclusion (or vice versa). The team also assessed and incorporated additional codes that were not present in the WA DOH query.

2. The CDC team reviewed the chief complaint terms and assessed whether they should be kept as inclusion or exclusion terms or removed from the definition.

3. The structure of the definition was modified to prioritize some discharge diagnosis codes (i.e., ICD-10 codes for watercraft-related injuries (V90-V94)), and to pair nonspecific terms for a boat or other type of recreational vessel with variables indicative of an incident or injury to increase specificity.

4. Participating jurisdictions classified visits into true and false positives and analyzed the positive predictive value (PPV) of the new definition. Multiple sub-versions of the v1 definition were iteratively analyzed and refined until the current v1 definition (described in detail below) was finalized.

How it works:

The Chief Complaint Discharge Diagnosis (CCDD) parsed field is used to query both the discharge diagnosis codes and chief complaint free text, and exclusions are incorporated as necessary. Initial visits for a new injury are captured in the first inclusion below if they contain an injury DD code for a primary encounter, which has the 7th character marked as A. All other inclusions capture visits with an injury if they exclude an injury DD code for a subsequent or sequalae injury, which has the 7th character marked as a D or S.

Inclusion based on boating accident discharge diagnosis codes for a primary encounter:
- The visit is automatically included if it contains:
  - 1. A discharge diagnosis code of drowning and submersion due to accident to watercraft (V90.XXXA) OR
  - 2. A discharge diagnosis code of other injury due to accident to watercraft (V91.XXXA) OR
  - 3. A discharge diagnosis code of drowning and submersion due to accident on board watercraft, without accident to watercraft (V92.XXXA) OR
  - 4. A discharge diagnosis code of other injury due to accident on board watercraft, without watercraft (V93.XXXA) OR
  - 5. A discharge diagnosis code of other and unspecified water transport accidents (V94.XXXA) OR
  - 6. A discharge diagnosis code of jumping or diving from boat (W16.7XXA) OR
Inclusion based on boating accident discharge diagnosis codes:
- The visit is included if it contains:
  - 1. A discharge diagnosis code of drowning and submersion due to accident to watercraft (V90) OR
  - 2. A discharge diagnosis code of other injury due to accident to watercraft (V91) OR
  - 3. A discharge diagnosis code of drowning and submersion due to accident on board watercraft, without accident to watercraft (V92) OR 3
  - 4. A discharge diagnosis code of other injury due to accident on board watercraft, without watercraft (V93) OR
  - 5. A discharge diagnosis code of other and unspecified water transport accidents (V94) OR
  - 6. A discharge diagnosis code of jumping or diving from boat (W16.7) OR
  - 7. A discharge diagnosis code of boat as the place of occurrence of the external cause (Y92.814)
- The above must exclude:
  - 1. A discharge diagnosis code of swimming pool in single-family (private) house or garden as the place of occurrence of the external cause (Y92.016) OR
  - 2. A discharge diagnosis code of intentional self-harm codes (X71-X83) OR
  - 3. A discharge diagnosis code of assault codes (X92-Y09) OR
  - 4. A discharge diagnosis code of any injury, poisoning, or external causes of morbidity codes for a subsequent or sequalae encounter (S, T, V-Y codes with a D or S code) OR
  - 5. Chief complaints related to a visit for something not related to a boating accident on a recreational vessel (“lift”, “pool”, “fish hook(s)”, “skiff”, “cruise ship”)
Inclusion based on discharge diagnosis code or chief complaint free text for use of a recreational vessel with a discharge diagnosis code or chief complaint free text of an incident or injury:
- 1. A discharge diagnosis code of an activity – rowing, canoeing, kayaking, rafting, and tubing (Y93.16) OR
  - 2. A discharge diagnosis code of an activity – water skiing and wake boarding (Y93.17) OR
  - 3. A discharge diagnosis code of an activity – other involving water and watercraft (Y93.19) OR
  - 4. Chief complaints related to a visit for a recreational vessel or other objects known be associated with boats (i.e., propeller) - (“boat”, “jetski”, “seadoo”, “watercraft”, “waverunner”, “wakeboard”, “waterski”, “propellor”, “propeller”, “propellar”, “tubing”) AND
  - 5. A discharge diagnosis code of any injury, poisoning, or external causes of morbidity codes (S, T, V-Y codes) OR
  - 6. Chief complaints related to a visit for an incident or injury (“accident”, “incident”, “crash”, “drown”, “hit”, “fall”, “fell”, “injur”, “lac”, “struck”, “caught”, “broke”, “sink”, “tip”, “capsize”, “flip”, “overt”)
- The above must exclude:
  - 1. A discharge diagnosis code of swimming pool in single-family (private) house or garden as the place of occurrence of the external cause (Y92.016) OR
  - 2. A discharge diagnosis code of intentional self-harm codes (X71-X83) OR
  - 3. A discharge diagnosis code of assault codes (X92-Y09) OR
  - 4. A discharge diagnosis code of any injury, poisoning, or external causes of morbidity codes for a subsequent or sequalae encounter (S, T, V-Y codes with a D or S code) OR
  - 5. Chief complaints related to a visit for something not related to a boating incident on a recreational vessel (“lift”, “pool”, “fish hook(s)”, “skiff”, “cruise ship”)
- For instances of “boat” in the chief complaint, it must also exclude:
  - 1. Chief complaints related to a visit for commercial boating, loading or moving a boat, and any mention of boat ramps or launches ("ferry”, “e ral”, “trailer”, “trailor”, “hitch”, “feel like”, “dock”, “ramp”, “launch”, “truck”, “load”, “moving a boat”, “toy”, “bumper”, “winch”, “barge”, “at work”, “shrimp”)
- For variations of propeller (“propeller”, “propellor”, “propellar”) in the chief complaint, it must also exclude:
  - 1. Chief complaints related to a visit for airplanes (“plane”)
- For instances of “tubing” in the chief complaint, it must also exclude:
  - 1. Chief complaints related to other types of tubing including catheter and oxygen tubing (“catheter”, “snow”, “oxygen tubing”, “O2 tubing”, “02 tubing”, “endo”, “metal”) OR
  - 2. A discharge diagnosis code of activities involving ice and snow (Y93.2)
Inclusion based on chief complaint free text for a raft, canoe, or kayak:
- 1. Chief complaints related to a visit for a raft, canoe, or kayak (“kayak”, “canoe”, “raft”) AND
- 2. Chief complaints related to a visit for a flipped, tipped, capsized, or overturned raft, canoe, or kayak (“flip”, “tip”, “capsize”, “overt”)
- The above must exclude:
  - 6. A discharge diagnosis code of swimming pool in single-family (private) house or garden as the place of occurrence of the external cause (Y92.016) OR
  - 7. A discharge diagnosis code of intentional self-harm codes (X71-X83) OR
  - 8. A discharge diagnosis code of assault codes (X92-Y09) OR
  - 9. A discharge diagnosis code of any injury, poisoning, or external causes of morbidity codes for a subsequent or sequalae encounter (S, T, V-Y codes with a D or S code) OR
  - 10. Chief complaints related to a visit for something not related to a boating incident on a recreational vessel (“lift”, “pool”, “fish hook(s)”, “skiff”, “cruise ship”)

For consideration:

This definition has some limitations, including false positives that remain, such as those who work on a boat and fishing-related injuries. Additionally, some visits reflect boating incidents caused by getting on or off a boat that was not in operation. Although true positives are determined based on chief complaints and discharge diagnoses (CCDD), several states used supplementary fields in ESSENCE, such as triage notes or clinical impression, to note false positives. This resulted in lower PPVs than classification based only on CCDD data.

Supporting documentation:

Recreational Boating Incidents v1 Factsheet & Technical Brief

Syndrome Definition

^;V9[0-4][0-9x][0-9x][0-9x]A^,or,^;W167[0-9x][0-9x]A^,or,(,^;Y92814^,or,^;V9[0- 4]^,or,^;W167^,or,(,(,(,^boat^,andnot,(,^ferry^,or,^e ral^,or,^trail[oe]r^,or,^hitch^,or,(,^ feel^,AND,^like^,),or,^dock^,or,^ramp^,or,^launch^,or,!truck!,or,^load^,or,^moving a boat^,or,^toy^,or,^bumper^,or,^winch^,or,^barge^,or,^at work^,or,^shrimp^,),),or,^;Y931[679]^,or,^jetski^,or,^jet ski^,or,!seadoo!,or,!sea doo!,or,^sea-doo^,or,^water craft^,or,^watercraft^,or,^waverunner^,or,^wave runner^,or,^wakeboard^,or,^wake board^,or,^waterski^,or,^water ski^,or,(,^propell[aeo]r^,andnot,^plane^,),or,(,(,^tubing^,AND,(,^f[ae]ll^,or,^injur^,or,^;[STV-Y][0-9][0-9]^,or,^tubing accident ^,or,^boat^,),),ANDNOT,(,^catheter^,or,^snow^,or,^oxygen tubing^,or,^[O0]2 tubing^,or,^endo^,or,^metal^,or,^;Y932^,),),),and,(,^;[STV-Y][0-9][0- 9]^,or,^accident^,or,^incident^,or,^crash^,or,^drown^,or,^ hit^,or,^f[ae]ll^,or,^injur^,or,^lac^,or,^struck^,or,^caught^,or,^broke^,or,^sink^,or,^ tip^,or,^capsize^,or,^flip^,or,^overt^,),),or,(,(,^kayak^,or,^canoe^,or,^ raft^,),and,(,^flip^,or,^tip^,or,^capsize^,or,^overt^,),),),ANDNOT,(,^lift^,or,^pool^,or,(,^fish^,AND,^hook^,),or,^skiff^ ,or,^cruise ship^,or,^;Y92016^,or,^;X7[1-9]^,or,^;X8[0-3]^,or,^;X9[2-9]^,or,^;Y0[0-9]^,or,^;[STV-Y][0-9][0-9][0- 9X][0-9X][0-9X][DS]^,)

Submitting Author Email

tfu3@cdc.gov

Submitted by rtugan on Tue, 07/11/2023 - 11:41