Using medical services claims to assess injuries in the elderly: sensitivity of diagnostic and procedure codes for injury ascertainment

The sensitivity of using physician claims data for injury ascertainment was examined in a cohort of 1,181 elderly who were treated in the emergency de partment of one of 10 hospitals for injuries in 1993-1994. The clinical rec ord of the type and date of injury was compared with diagnostic and procedu re codes in the Quebec health insurance agency records of physician billing claims for the same patients. The proportion of patients correctly classif ied by claims data was determined for the exact date of injury and for a ti me window around the date of injury. The most common injuries were fracture s (55.4%) and lacerations (19.3%), and 78.9% of injuries were fall related. Overall, the combination of treatment procedure codes and diagnostic codes provided the most sensitive measure of injury occurrence; a sensitivity of 67.3% for the exact date and 81.3% for an expanded data window (95.6% of i njuries were within - 1 day to + 3 days of the injury date). Sensitivity va ried by injury type form a low of 14% for abrasions to a high of 97.2% for hip fractures. The combination of diagnostic and procedure codes in physici an claims is a sensitive indicator of some common injuries that would not b e documented in hospitalization databases. (C) 2000 Elsevier Science Inc. A ll rights reserved.