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Completeness of cause of injury coding in healthcare administrative databases in the United States, 2001

¹ Injury Control Research Center, West Virginia University, Morgantown, WV, USA
² Agency for Healthcare Research and Quality, Center for Delivery, Organization, and Markets, Rockville, MD, USA
³ M.L. Barrett, Inc, San Diego, CA, USA
⁴ Medstat, Washington, DC, USA

Correspondence to:
Dr J H Coben
Injury Control Research Center, West Virginia University, PO Box 9151, Morgantown, WV 26506-9151, USA; jcoben{at}hsc.wvu.edu

ABSTRACT
Objectives: To determine the completeness of external cause of injury coding (E-coding) within healthcare administrative databases in the United States and to identify factors that contribute to variations in E-code reporting across states.

Design: Cross sectional analysis of the 2001 Healthcare Cost and Utilization Project (HCUP), including 33 State Inpatient Databases (SID), a Nationwide Inpatient Sample (NIS), and nine State Emergency Department Databases (SEDD). To assess state reporting practices, structured telephone interviews were conducted with the data organizations that participate in HCUP.

Results: The percent of injury records with an injury E-code was 86% in HCUP’s nationally representative database, the NIS. For the 33 states represented in the SID, completeness averaged 87%, with more than half of the states reporting E-codes on at least 90% of injuries. In the nine states also represented in the SEDD, completeness averaged 93%. Twenty two states had mandates for E-code reporting, but only eight had provisions for enforcing the mandates. These eight states had the highest rates of E-code completeness.

Conclusions: E-code reporting in administrative databases is relatively complete, but there is significant variation in completeness across the states. States with mandates for the collection of E-codes and with a mechanism to enforce those mandates had the highest rates of E-code reporting. Nine statewide ED data systems demonstrate consistently high E-coding completeness.

Abbreviations: AHRQ, Agency for Healthcare Research and Quality; CSTE, Council of State and Territorial Epidemiologists; HCUP, Healthcare Cost and Utilization Project; NHAMCS, National Hospital Ambulatory Medical Care Survey; NIS, Nationwide Inpatient Sample; SEDD, State Emergency Department Databases; SID, State Inpatient Databases

Keywords: E-codes; injury coding; administrative data