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Emergency department coding of bicycle and pedestrian injuries during the transition from ICD-9 to ICD-10
  1. M Karkhaneh1,
  2. B E Hagel2,3,
  3. A Couperthwaite4,
  4. L D Saunders1,
  5. D C Voaklander1,5,
  6. B H Rowe1,4
  1. 1School of Public Health, University of Alberta, Edmonton, Alberta, Canada
  2. 2Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
  3. 3Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  4. 4Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
  5. 5Alberta Centre for Injury Control and Research, Edmonton, Alberta, Canada
  1. Correspondence to Brian H Rowe, Department of Emergency Medicine, University of Alberta, 1G1.43 Walter C. Mackenzie Centre, 8440-112th Street, Edmonton, Alberta T6L 2B7, Canada;brian.rowe{at}


Background The international classification of diseases version 10 (ICD-10) uses alphanumeric expanded codes and external cause of injury codes (E-codes).

Objective To examine the reliability and validity of emergency department (ED) coders in applying E-codes in ICD-9 and -10.

Methods Bicycle and pedestrian injuries were identified from the ED information system from one period before and two periods after transition from ICD-9 to -10 coding. Overall, 180 randomly selected bicycle and pedestrian injury charts were reviewed as the reference standard (RS). Original E-codes assigned by ED coders (ICD-9 in 2001 and ICD-10 in 2004 and 2007) were compared with charts (validity) and also to ICD-9 and -10 codes assigned from RS chart review, to each case by an independent (IND) coder (reliability). Sensitivity, specificity, simple, and chance-corrected agreements (κ statistics) were calculated.

Results Sensitivity of E-coding bicycle injuries by the IND coder in comparison with the RS ranged from 95.1% (95% CI 86.3 to 99.0) to 100% (95% CI 94.0 to 100.0) for both ICD-9 and -10. Sensitivity of ED coders in E-coding bicycle injuries ranged from 90.2% (95% CI 79.8 to 96.3) to 96.7% (95% CI 88.5 to 99.6). The sensitivity estimates for the IND coder ranged from 25.0% (95% CI 14.7 to 37.9) to 45.0% (95% CI 32.1 to 58.4) for pedestrian injuries for both ICD-9 and -10.

Conclusion Bicycle injuries are coded in a reliable and valid manner; however, pedestrian injuries are often miscoded as falls. These results have important implications for injury surveillance research.

  • Reliability
  • ICD codes
  • bicycling
  • pedestrian
  • injury
  • bicycle
  • e-code
  • pedestrian
  • surveillance

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  • Funding BEH holds the Alberta Children's Hospital Foundation Professorship in Child Health and Wellness, funded through the support of an anonymous donor and the Canadian National Railway Company, as well as the Alberta Heritage Foundation for Medical Research Population Health Investigator and Canadian Institutes of Health Research New Investigator Awards, Alberta, Canada. BHR is supported by the Government of Canada as a 21st Century Canada Research Chair in Emergency Medicine.

  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the University of Alberta Health Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.