Using Chief Complaint in Addition to Diagnosis Codes to Identify Falls in the Emergency Department. - PubMed - NCBI
About 20 percent more emergency department visits by older patients would be attributed to falls if hospital screening took into account patients’ chief complaint in addition to diagnosis codes, an AHRQ-funded study concluded. An analysis of electronic health records at an academic medical center during a 33-month study period identified about 4,400 fall-related visits among people 65 or older. More than 850 of those were not classified as fall related, however, because visits were recorded with ICD-9 codes alone. Those patients whose visits were not classified as fall related were less likely to be admitted but were associated with higher baseline comorbidity, which suggests that defining falls based only on coding underestimates the true burden of falls. Including patients’ chief complaint along with diagnosis codes will help identify more people in the ED who have fallen, which will help guide future research and policy, as well as provide clinical care for the most at-risk population, authors concluded. The study appeared in
Journal of American Geriatric Society. Access the
abstract.
Using Chief Complaint in Addition to Diagnosis Codes to Identify Falls in the Emergency Department.
Patterson BW1,2,
Smith MA2,3,4,
Repplinger MD1,5,
Pulia MS1,
Svenson JE1,
Kim MK1,
Shah MN1,6.
Abstract
OBJECTIVES:
To compare incidence of falls in an emergency department (ED) cohort using a traditional International Classification of Diseases, Ninth Revision (ICD-9) code-based scheme and an expanded definition that included chief complaint information and to examine the clinical characteristics of visits "missed" in the ICD-9-based scheme. DESIGN:
Retrospective electronic record review. SETTING:
Academic medical center ED. PARTICIPANTS:
Individuals aged 65 and older seen in the ED between January 1, 2013, and September 30, 2015. MEASUREMENTS:
Two fall definitions were applied (individually and together) to the cohort: an ICD-9-based definition and a chief complaint definition. Admission rates and 30-day mortality (per encounter) were measured for each definition. RESULTS:
Twenty-three thousand eight hundred eighty older adult visits occurred during the study period. Using the most-inclusive definition (ICD-9 code or chief complaint indicating a fall), 4,363 visits (18%) were fall related. Of these visits, 3,506 (80%) met the ICD-9 definition for a fall-related visit, and 2,664 (61%) met the chief complaint definition. Of visits meeting the chief complaint definition, 857 (19.6%) were missed when applying the ICD-9 definition alone. Encounters missed using the ICD-9 definition were less likely to lead to an admission (42.9%, 95% confidence interval (CI) = 39.7-46.3%) than those identified (54.4%, 95% CI = 52.7-56.0%). CONCLUSION:
Identifying individuals in the ED who have fallen based on diagnosis codes underestimates the true burden of falls. Individuals missed according to the code-based definition were less likely to have been admitted than those who were captured. These findings call attention to the value of using chief complaint information to identify individuals who have fallen in the ED-for research, clinical care, or policy reasons. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.
KEYWORDS:
chief complaint; emergency department; falls
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