Bota G W, Therrien S A, Rowe B H
Sudbury General Hospital, Emergency Department, Ontario, Canada.
Acad Emerg Med. 1997 Apr;4(4):291-6. doi: 10.1111/j.1553-2712.1997.tb03551.x.
ED injury surveillance requires accurate information about mechanism. This study explored the clinometric properties of an E-code system specifically designed to track ED injuries.
All patients assessed in the ED had cause-of-injury information documented using a truncated E-code system. Patient records were hand-searched to determine coding compliance. A selection of 98 charts (50 injury/48 noninjury) were coded by 7 physicians, 2 nurses, and 2 nosologists. Agreements (interrater and intrarater) on the diagnosis of trauma and exact E-codes were determined (using kappa; kappa).
E-coding compliance was high (overall 90%: 95% CI: 85-93%), and accuracy of injury classification was 99%. Compared with an expert's coding, agreement on injury classification was excellent for physicians (kappa = 0.91; 95% CI: 0.80-1.0), nurses (kappa = 0.88; 95% CI: 0.75-1.0), and nosologists (kappa = 0.92; 95% CI: 0.81-1.0). Agreement was substantial for the exact E-codes between physicians (kappa = 0.77; 95% CI: 0.60-0.94) and nurses (kappa = 0.72; 95% CI: 0.54-0.90). Recode reliability was also excellent for physicians (kappa = 0.88; 95% CI: 0.75-1.0) and nurses (kappa = 0.96; 95% CI: 0.88-1.0).
Injury coding using a truncated E-code system can provide valid and reliable data from the ED. Differences between nurses, physicians, and nosologists in the ability to accurately code using this system were minimal, thus eliminating the need for additional staff and resources.
急诊损伤监测需要有关损伤机制的准确信息。本研究探讨了专门设计用于追踪急诊损伤的E编码系统的临床测量特性。
在急诊接受评估的所有患者均使用简化的E编码系统记录损伤原因信息。人工查阅患者记录以确定编码合规性。98份病历（50份损伤/48份非损伤）由7名医生、2名护士和2名疾病分类学家进行编码。确定了（使用kappa系数）在创伤诊断和确切E编码方面的一致性（评分者间和评分者内）。
E编码合规率很高（总体为90%：95%可信区间：85 - 93%），损伤分类准确率为99%。与专家编码相比，医生（kappa = 0.91；95%可信区间：0.80 - 1.0）、护士（kappa = 0.88；95%可信区间：0.75 - 1.0）和疾病分类学家（kappa = 0.92；95%可信区间：0.81 - 1.0）在损伤分类方面的一致性极佳。医生（kappa = 0.77；95%可信区间：0.60 - 0.94）和护士（kappa = 0.72；95%可信区间：0.54 - 0.90）在确切E编码方面的一致性较高。医生（kappa = 0.88；95%可信区间：0.75 - 1.0）和护士（kappa = 0.96；95%可信区间：0.88 - 1.0）的重新编码可靠性也极佳。
使用简化的E编码系统进行损伤编码能够从急诊提供有效且可靠的数据。护士、医生和疾病分类学家在使用该系统进行准确编码的能力上差异极小，因此无需额外的人员和资源。
