Accuracy of external cause-of-injury coding in VA polytrauma patient discharge records

Kathleen Carlson, Sean M. Nugent, Joseph Grill, Nina A. Sayer

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Valid and efficient methods of identifying the etiology of treated injuries are critical for characterizing patient populations and developing prevention and rehabilitation strategies. We examined the accuracy of external cause-of-injury codes (E-codes) in Veterans Health Administration (VHA) administrative data for a population of injured patients. Chart notes and E-codes were extracted for 566 patients treated at any one of four VHA Polytrauma Rehabilitation Center sites between 2001 and 2006. Two expert coders, blinded to VHA E-codes, used chart notes to assign "gold standard" E-codes to injured patients. The accuracy of VHA E-coding was examined based on these gold standard E-codes. Only 382 of 517 (74%) injured patients were assigned E-codes in VHA records. Sensitivity of VHA E-codes varied significantly by site (range: 59%-91%, p <0.001). Sensitivity was highest for combat-related injuries (81%) and lowest for fall-related injuries (60%). Overall specificity of E-codes was high (92%). E-coding accuracy was markedly higher when we restricted analyses to records that had been assigned VHA E-codes. E-codes may not be valid for ascertaining source-of-injury data for all injuries among VHA rehabilitation inpatients at this time. Enhanced training and policies may ensure more widespread, standardized use and accuracy of E-codes for injured veterans treated in the VHA.

Original languageEnglish (US)
Pages (from-to)689-698
Number of pages10
JournalJournal of Rehabilitation Research and Development
Volume47
Issue number8
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

Patient Discharge
Multiple Trauma
Veterans Health
United States Department of Veterans Affairs
Wounds and Injuries
Rehabilitation
Rehabilitation Centers
Information Storage and Retrieval
Veterans

Keywords

  • Administrative data
  • Causes of injury
  • E-codes
  • Hospital discharge records
  • Icd codes
  • Injury surveillance
  • Medical records
  • Missing data
  • Rehabilitation
  • Veterans

ASJC Scopus subject areas

  • Rehabilitation

Cite this

Accuracy of external cause-of-injury coding in VA polytrauma patient discharge records. / Carlson, Kathleen; Nugent, Sean M.; Grill, Joseph; Sayer, Nina A.

In: Journal of Rehabilitation Research and Development, Vol. 47, No. 8, 2010, p. 689-698.

Research output: Contribution to journalArticle

@article{b4fbf82bed6d48e6aa0543a73e204116,
title = "Accuracy of external cause-of-injury coding in VA polytrauma patient discharge records",
abstract = "Valid and efficient methods of identifying the etiology of treated injuries are critical for characterizing patient populations and developing prevention and rehabilitation strategies. We examined the accuracy of external cause-of-injury codes (E-codes) in Veterans Health Administration (VHA) administrative data for a population of injured patients. Chart notes and E-codes were extracted for 566 patients treated at any one of four VHA Polytrauma Rehabilitation Center sites between 2001 and 2006. Two expert coders, blinded to VHA E-codes, used chart notes to assign {"}gold standard{"} E-codes to injured patients. The accuracy of VHA E-coding was examined based on these gold standard E-codes. Only 382 of 517 (74{\%}) injured patients were assigned E-codes in VHA records. Sensitivity of VHA E-codes varied significantly by site (range: 59{\%}-91{\%}, p <0.001). Sensitivity was highest for combat-related injuries (81{\%}) and lowest for fall-related injuries (60{\%}). Overall specificity of E-codes was high (92{\%}). E-coding accuracy was markedly higher when we restricted analyses to records that had been assigned VHA E-codes. E-codes may not be valid for ascertaining source-of-injury data for all injuries among VHA rehabilitation inpatients at this time. Enhanced training and policies may ensure more widespread, standardized use and accuracy of E-codes for injured veterans treated in the VHA.",
keywords = "Administrative data, Causes of injury, E-codes, Hospital discharge records, Icd codes, Injury surveillance, Medical records, Missing data, Rehabilitation, Veterans",
author = "Kathleen Carlson and Nugent, {Sean M.} and Joseph Grill and Sayer, {Nina A.}",
year = "2010",
doi = "10.1682/JRRD.2009.08.0118",
language = "English (US)",
volume = "47",
pages = "689--698",
journal = "Journal of rehabilitation R&D",
issn = "0007-506X",
publisher = "Department of Veterans Affairs",
number = "8",

}

TY - JOUR

T1 - Accuracy of external cause-of-injury coding in VA polytrauma patient discharge records

AU - Carlson, Kathleen

AU - Nugent, Sean M.

AU - Grill, Joseph

AU - Sayer, Nina A.

PY - 2010

Y1 - 2010

N2 - Valid and efficient methods of identifying the etiology of treated injuries are critical for characterizing patient populations and developing prevention and rehabilitation strategies. We examined the accuracy of external cause-of-injury codes (E-codes) in Veterans Health Administration (VHA) administrative data for a population of injured patients. Chart notes and E-codes were extracted for 566 patients treated at any one of four VHA Polytrauma Rehabilitation Center sites between 2001 and 2006. Two expert coders, blinded to VHA E-codes, used chart notes to assign "gold standard" E-codes to injured patients. The accuracy of VHA E-coding was examined based on these gold standard E-codes. Only 382 of 517 (74%) injured patients were assigned E-codes in VHA records. Sensitivity of VHA E-codes varied significantly by site (range: 59%-91%, p <0.001). Sensitivity was highest for combat-related injuries (81%) and lowest for fall-related injuries (60%). Overall specificity of E-codes was high (92%). E-coding accuracy was markedly higher when we restricted analyses to records that had been assigned VHA E-codes. E-codes may not be valid for ascertaining source-of-injury data for all injuries among VHA rehabilitation inpatients at this time. Enhanced training and policies may ensure more widespread, standardized use and accuracy of E-codes for injured veterans treated in the VHA.

AB - Valid and efficient methods of identifying the etiology of treated injuries are critical for characterizing patient populations and developing prevention and rehabilitation strategies. We examined the accuracy of external cause-of-injury codes (E-codes) in Veterans Health Administration (VHA) administrative data for a population of injured patients. Chart notes and E-codes were extracted for 566 patients treated at any one of four VHA Polytrauma Rehabilitation Center sites between 2001 and 2006. Two expert coders, blinded to VHA E-codes, used chart notes to assign "gold standard" E-codes to injured patients. The accuracy of VHA E-coding was examined based on these gold standard E-codes. Only 382 of 517 (74%) injured patients were assigned E-codes in VHA records. Sensitivity of VHA E-codes varied significantly by site (range: 59%-91%, p <0.001). Sensitivity was highest for combat-related injuries (81%) and lowest for fall-related injuries (60%). Overall specificity of E-codes was high (92%). E-coding accuracy was markedly higher when we restricted analyses to records that had been assigned VHA E-codes. E-codes may not be valid for ascertaining source-of-injury data for all injuries among VHA rehabilitation inpatients at this time. Enhanced training and policies may ensure more widespread, standardized use and accuracy of E-codes for injured veterans treated in the VHA.

KW - Administrative data

KW - Causes of injury

KW - E-codes

KW - Hospital discharge records

KW - Icd codes

KW - Injury surveillance

KW - Medical records

KW - Missing data

KW - Rehabilitation

KW - Veterans

UR - http://www.scopus.com/inward/record.url?scp=78449313432&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78449313432&partnerID=8YFLogxK

U2 - 10.1682/JRRD.2009.08.0118

DO - 10.1682/JRRD.2009.08.0118

M3 - Article

C2 - 21110244

AN - SCOPUS:78449313432

VL - 47

SP - 689

EP - 698

JO - Journal of rehabilitation R&D

JF - Journal of rehabilitation R&D

SN - 0007-506X

IS - 8

ER -