Journal of Rehabilitation Research & Development (JRRD)

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Volume 47 Number 8, 2010
   Pages 689 — 698

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

Kathleen F. Carlson, MS, PhD;1-2* Sean M. Nugent, BA;1 Joseph Grill, MS;1 Nina A. Sayer, PhD1-2

1Center for Chronic Disease Outcomes Research, Department of Veterans Affairs Medical Center, Minneapolis, MN; 2Department of Medicine, University of Minnesota Medical School, Minneapolis, MN

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.

Key words: administrative data, causes of injury, E-codes, hospital discharge records, ICD codes, injury surveillance, medical records, missing data, rehabilitation, veterans.

This article and any supplementary material should be cited as follows:
Carlson KF, Nugent SM, Grill J, Sayer NA. Accuracy of external cause-of-injury coding in VA polytrauma patient discharge records. J Rehabil Res Dev. 2010;47(8):689-98.
DOI: 10.1682/JRRD.2009.08.0118
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Last Reviewed or Updated  Wednesday, October 27, 2010 1:29 PM

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