Objective: To appraise the published evidence regarding the accuracy of external cause-of-injury codes in hospital records.
Design: Systematic review.
Data sources: Electronic databases searched included PubMed, PubMed Central, Medline, CINAHL, Academic Search Elite, Proquest Health and Medical Complete, and Google Scholar. Snowballing strategies were used by searching the bibliographies of retrieved references to identify relevant associated articles.
Selection criteria: Studies were included in the review if they assessed the accuracy of external cause-of-injury coding in hospital records via a recoding methodology.
Methods: The papers identified through the search were independently screened by two authors for inclusion. Because of heterogeneity between studies, meta-analysis was not performed.
Results: Very limited research on the accuracy of external cause coding for injury-related hospitalisation using medical record review and recoding methodologies has been conducted, with only five studies matching the selection criteria. The accuracy of external cause coding using ICD-9-CM ranged from ∼ 64% when exact code agreement was examined to ∼85% when agreement for broader groups of codes was examined.
Conclusions: Although broad external cause groupings coded in ICD-9-CM can be used with some confidence, researchers should exercise caution for very specific codes until further research is conducted to validate these data. As all previous studies have been conducted using ICD-9-CM, research is needed to quantify the accuracy of coding using ICD-10-AM, and validate the use of these data for injury surveillance purposes.
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Contributors: KM contributed to the conceptual design of the manuscript, and was responsible for conducting the systematic literature review, writing the first draft of the manuscript, compiling all authors’ responses, and preparing the final version of the manuscript. ELE-M contributed to the conceptual design of the manuscript, assisted with the systematic literature review, and reviewed and commented on each draft of the manuscript. SW contributed to the conceptual design of the manuscript, provided context to the manuscript in terms of clinical coding processes, and reviewed and commented on each draft of the manuscript. RJM contributed to the conceptual design of the manuscript, provided context to the manuscript in terms of injury prevention implications, and reviewed and commented on each draft of the manuscript. JEH contributed to the conceptual design of the manuscript, and provided context to the manuscript in terms of injury surveillance implications.
Funding: This research is funded by an Australian Research Council Linkage Project grant, Injury Prevention and Control Australia, the Victorian Department of Human Services, and the Queensland Health - Health Information Centre.
Competing interests: None.
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