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Completeness and accuracy of International Classification of Disease (ICD) external cause of injury codes in emergency department electronic data
  1. P R Hunt1,
  2. H Hackman2,
  3. G Berenholz3,
  4. L McKeown4,
  5. L Davis1,
  6. V Ozonoff4
  1. 1
    Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, MA, USA
  2. 2
    Injury Prevention and Control Program, Massachusetts Department of Public Health, Boston, MA, USA
  3. 3
    Berenholz Consulting Associates, Lexington, MA, USA
  4. 4
    Injury Surveillance Program, Massachusetts Department of Public Health, Boston, MA, USA
  1. Dr P R Hunt, Occupational Health Surveillance Program, Massachusetts Department of Public Health, 250 Washington St, Sixth Floor, Boston, MA 02108, USA; Phill.hunt{at}state.ma.us

Abstract

The accuracy of external cause of injury codes (E codes) for work-related and non-work-related injuries in Massachusetts emergency department data were evaluated. Medical records were reviewed and coded by a nosologist with expertise in E coding for a stratified random sample of 1000 probable work-related (PWR) and 250 probable non-work-related (PNWR) cases. Cause of injury E codes were present for 98% of reviewed cases and accurate for 65% of PWR cases and 57% of PNWR cases. Place of occurrence E codes were present in less than 30% of cases. Broad cause of injury categories were accurate for about 85% of cases. Non-specific categories (not elsewhere classified, not specified) accounted for 34% of broad category misclassifications. Among specified causes, machinery injuries were misclassified most often (39/60, 65%), predominantly as cut/pierce or struck by/against. E codes reliably identify the broad mechanism of injury, but inaccuracies and incompleteness suggest areas for training of hospital admissions staff, providers, and coders.

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Footnotes

  • This work was funded by grant number RO1 OH04262 from the United States Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.

  • Competing interests: None.

  • Abbreviations:
    ED
    emergency department
    EDISS
    Emergency Department Injury Surveillance System
    ICD
    International Classification of Disease
    ICD-9-CM
    ICD Ninth Revision Clinical Modification
    PNWR
    probable non-work-related
    PWR
    probable work-related

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