Patterson Brian W, Smith Maureen A, Repplinger Michael D, Pulia Michael S, Svenson James E, Kim Michael K, Shah Manish N
BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
Health Innovation Program, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
J Am Geriatr Soc. 2017 Sep;65(9):E135-E140. doi: 10.1111/jgs.14982. Epub 2017 Jun 21.
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.
Retrospective electronic record review.
Academic medical center ED.
Individuals aged 65 and older seen in the ED between January 1, 2013, and September 30, 2015.
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.
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%).
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.
比较使用传统的基于国际疾病分类第九版（ICD - 9）编码方案和包含主诉信息的扩展定义时，急诊科（ED）队列中的跌倒发生率，并检查基于ICD - 9方案中“遗漏”就诊的临床特征。
回顾性电子病历审查。
学术医疗中心急诊科。
2013年1月1日至2015年9月30日期间在急诊科就诊的65岁及以上个体。
对该队列应用两种跌倒定义（单独应用和一起应用）：基于ICD - 9的定义和主诉定义。测量每种定义的入院率和30天死亡率（每次就诊）。
研究期间发生了23,880次老年成人就诊。使用最全面的定义（ICD - 9编码或表明跌倒的主诉），4363次就诊（18%）与跌倒相关。在这些就诊中，3506次（80%）符合跌倒相关就诊的ICD - 9定义，2664次（61%）符合主诉定义。在符合主诉定义的就诊中，仅应用ICD - 9定义时，857次（19.6%）被遗漏。与被识别出的就诊（54.4%，95%置信区间（CI）= 52.7 - 56.0%）相比，使用ICD - 9定义遗漏的就诊导致入院的可能性较小（42.9%，95% CI = 39.7 - 46.3%）。
基于诊断编码识别急诊科中跌倒的个体低估了跌倒的真实负担。根据基于编码的定义遗漏的个体比被捕获的个体入院的可能性更小。这些发现提醒人们注意，出于研究、临床护理或政策原因，利用主诉信息识别急诊科中跌倒个体的价值。
