A TRUNCATED E-CODE SYSTEM FOR INJURY SURVEILLANCE IN THE EMERGENCY DEPARTMENT - DESCRIPTION AND CLINOMETRIC TESTING

Objectives: ED injury surveillance requires accurate information about mechanism. This study explored the clinometric properties of an E-cod e system specifically designed to track ED injuries. Methods: All pati ents assessed in the ED had cause-of-injury information documented usi ng a truncated E-code system. Patient records were hand-searched to de termine coding compliance. A selection of 98 charts (50 injury/48 noni njury) were coded by 7 physicians, 2 nurses, and 2 nosologists. Agreem ents (interrater and intrarater) on the diagnosis of trauma and exact E-codes were determined (using kappa; kappa). Results: E-coding compli ance was high (overall 90%: 95% CI: 85-93%), and accuracy of injury cl assification was 99%. Compared with an expert's coding, agreement on i njury classification was excellent for physicians (kappa = 0.91; 95% C I: 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 e xact 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). Conclusions: Injury coding using a tr uncated E-code system can provide valid and reliable data from the ED. Differences between nurses, physicians, and nosologists in the abilit y to accurately code using this system were minimal, thus eliminating the need for additional staff and resources.