Underreporting of external cause codes in the Finnish Hospital Discharge Register

Abstract

Background: Hospital discharge data (HDD) represent one of the most valuable information sources for injury prevention and control. Objectives: To investigate external code of injury (E-code) underreporting in the Finnish National Hospital Discharge Register from 1 January 1987 to 31 December 2004. Material and methods: HDD for discharges with an injury as the main diagnosis were extracted from the FNHDR. The selection was made using codes for nature of injury (1987—1995, ICD-9; 1996—2004, ICD-10). The proportion of injury discharges with a missing E-code was examined by sex, age, hospital districts, type of hospital, duration of hospitalization, and nature of injury. Results: In 432,549 (23.1%) of the recorded 1,868,519 discharges, an E-code was missing. The proportion of the discharges with a missing E-code varied among the above variables. During the period 1987—2004, the overall E-code underreporting decreased from 18.0% to 12.8%. The introduction of the ICD-10 in 1996 was followed by a dramatic increase (up to 57.5% of all discharges) in E-code underreporting. Conclusions: More attention ought to be dedicated to teaching and periodic training on the use of E-codes. Educational activities should specifically target the medical doctors, who, in Finland, are responsible for assigning the E-codes.

Keywords

E-code hospital discharge register ICD-9 ICD-10 injury morbidity underreporting

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References

Guyer B. , Berenholz G. , Gallagher SS Injury surveillance using hospital discharge abstracts coded by external cause of injury (E code). J Trauma 1990;30:470-3.

Sniezek JE , Finklea JF , Graitcer PL Injury coding and hospital discharge data . JAMA 1989;262:2270-2.

LeMier M. , Cummings P. , West TA Accuracy of external cause of injury codes reported in Washington State hospital discharge records. Injury Prevention 2001;7:334-8.

Coben JH , Steiner CA , Barett M. , Merill CT , Adamson D. Completeness of cause of injury coding in healthcare administrative databases in the United States, 2001. Injury Prevention 2006;12:199-201.

World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th revision. Geneva: WHO; 1992.

Marganitt B. , MacKenzie EJ , Smith GS , Damiano AM Coding external causes of injury (E-codes) in Maryland hospital discharges 1979-88: a statewide study to explore the uncoded population. Am J Public Health 1990 ;80:1463-6.

Hall MJ , Owings MF Hospitalizations for injury and poisoning in the United States, 1991. Adv Data 1994;252:1-12.

World Health Organization. Manual of the International Statistical Classification of Diseases and Related Health Problems, 9th revision. Geneva: WHO; 1977.

Stakes. Finnish version of the International Statistical Classification of Diseases and Related Health Problems. 2nd edn, 10th revision, 1999.

10.

Centers for Disease Control and Prevention. External cause-of-injury coding in hospital discharge data - United States, 1992. MMWR 1992;41:249-51.

11.

Centers for Disease Control and Prevention. Update: external cause-of-injury coding in hospital discharge data - United States, 1994. MMWR 1994;43:465-7.

12.

Langlois JA , Buechner JS , O'Connor EA , Nacar EQ , Smith GS

Improving the E coding of hospitalizations for injury: do hospital records contain adequate documentation?

Am J Public Health 1995;85:1261-5.

13.

Hall MJ , Owings MF Hospitalizations for injury: United States, 1996. Adv Data 2000;318:1-9.

14.

Tavris DR , Kuhn EM , Layde PM Hospitalizations for vehicle associated injuries in Wisconsin. Wisconsin Med J 1999;98:34-9.

15.

Salmela R. , Koistinen V. Reliability and coverage of the discharge register in general hospitals. Sairaala 1987 ;49: 480-2 (in Finnish).

16.

Honkonen R. Hospitalization due to injury in Finland in 1980: statistics and reviews 1/90 . Kuopio, Finland: University of Kuopio; 1990.

17.

Keskimäki I. , Aro S. Accuracy of data on diagnosis, procedures and accidents in the Finnish hospital discharge register. Int J Health Sci 1991;2:15-21.

18.

Mattila VM , Parkkari J. , Korpela H. , Pihlajamaki H. Hospitalisation for injuries among Finnish conscripts in 1990-1999. Accid Anal Prevention 2006;38:99-104.

19.

National Board of Health and Welfare. The Swedish Hospital Discharge Register. Available at: http://www.socialstyrelsen.se/Statistik (accessed 21 May 2007).

20.

Smith GS , Langlois JA , Buechner JS Methodological issues in using hospital discharge data to determine the incidence of hospitalized injuries. Am J Epidemiol 1991 ;134:1146-58.

21.

Blanc PD , Jones MR , Olson KR Surveillance of poisoning and drug overdose through hospital discharge coding, poison control center reporting, and the Drug Abuse Warning Network. Am J Emerg Med 1993;11:14-19.

22.

Schwartz RJ , Nightingale BS , Boisoneau D. Accuracy of e-codes assigned to emergency department records. Acad Emerg Med 1995;2:615-20.

23.

Rhodes AE , Links PS , Streiner DL , Dawe I. , Cass D. , Janes S.

Do hospital E-codes consistently capture suicidal behaviour?

Chronic Dis Can 2002;23:139-145.

24.

Agran PF , Anderson C. , Winn D. , Trent R. , Walton-Haynes L. , Thayer S. Rates of pediatric injuries by 3-month intervals for children 0 to 3 years of age. Pediatrics 2003;111:e683-92.

25.

Stephenson S. , Henley G. , Harrison JE , Langley JD Diagnosis based injury severity scaling: investigation of a method using Australian and New Zealand hospitalisations. Injury Prevention 2004;10:379-83.