Accuracy of administrative data in trauma: Splenic injuries as an example

Background: Accurate data are needed to evaluate clinical outcomes, therape utic modalities, and quality of care in trauma. Administrative data, usuall y used for billing, have been used to evaluate performance and assess thera py in other medical specialties. This study was performed to determine whet her administrative databases are accurate in the recording of information a bout trauma patients with splenic injuries. Methods: Patients who had blunt splenic injuries were identified using a st ate trauma registry. The medical records of those patients were reviewed. T he data collected by chart review were compared with data in the statewide administrative database of patients who had splenic injuries at the same fo ur Level I and II trauma centers in the same 5-year period. Age, sex, admis sion date, and hospital were matched to assure comparison of the identical cohort. chi(2) analysis was used to compare dichotomous data and Student's t test continuous data. Results: The administrative database identified 641 and the trauma registry identified 529 patients with a diagnosis of splenic injury. A total of 401 patients were found in both databases. Of these, 120 (22.7%) patients were not recorded in the administrative database. Injury Severity Score was und erreported by the administrative database (25.74 +/- 14.7 vs. 19.52 +/- 11, p < 0.0001). The administrative database underreported orthopedic, chest, and head injuries (317 vs. 215, 325 vs. 228, and 234 vs. 155, respectively; all p < 0.0001). Use of abdominal computed tomographic scan and diagnostic peritoneal lavage were also underreported (260 vs. 56 and 104 vs. 17, both p < 0.0001). The number of operations on the spleen and number of orthoped ic procedures were underreported (259 vs. 225, p < 0.014 and 147 vs. 94, p < 0.0001). Complications were markedly underreported by the administrative database (200 vs. 47, p < 0.0001) Conclusion: This study shows that administrative data lack accuracy in the recording of associated injuries, injury severity, diagnostics, procedures, and outcomes data in patients with splenic injuries. Whether these data sh ould be used to evaluate treatment modalities or quality of care in trauma is questionable.