RT Journal Article SR Electronic T1 Emergency department coding of bicycle and pedestrian injuries during the transition from ICD-9 to ICD-10 JF Injury Prevention JO Inj Prev FD BMJ Publishing Group Ltd SP 88 OP 93 DO 10.1136/ip.2010.031302 VO 18 IS 2 A1 M Karkhaneh A1 B E Hagel A1 A Couperthwaite A1 L D Saunders A1 D C Voaklander A1 B H Rowe YR 2012 UL http://injuryprevention.bmj.com/content/18/2/88.abstract AB 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.