5 years ago

Using Chief Complaint in Addition to Diagnosis Codes to Identify Falls in the Emergency Department

Manish N. Shah, Michael D. Repplinger, Maureen A. Smith, James E. Svenson, Brian W. Patterson, Michael S. Pulia, Michael K. Kim
Objectives To compare incidence of falls in an emergency department (ED) cohort using a traditional International Classification of Diseases, Ninth Revision (ICD-9) code–based scheme and an expanded definition that included chief complaint information and to examine the clinical characteristics of visits “missed” in the ICD-9-based scheme. Design Retrospective electronic record review. Setting Academic medical center ED. Participants Individuals aged 65 and older seen in the ED between January 1, 2013, and September 30, 2015. Measurements Two fall definitions were applied (individually and together) to the cohort: an ICD-9-based definition and a chief complaint definition. Admission rates and 30-day mortality (per encounter) were measured for each definition. Results Twenty-three thousand eight hundred eighty older adult visits occurred during the study period. Using the most-inclusive definition (ICD-9 code or chief complaint indicating a fall), 4,363 visits (18%) were fall related. Of these visits, 3,506 (80%) met the ICD-9 definition for a fall-related visit, and 2,664 (61%) met the chief complaint definition. Of visits meeting the chief complaint definition, 857 (19.6%) were missed when applying the ICD-9 definition alone. Encounters missed using the ICD-9 definition were less likely to lead to an admission (42.9%, 95% confidence interval (CI) = 39.7–46.3%) than those identified (54.4%, 95% CI = 52.7–56.0%). Conclusion Identifying individuals in the ED who have fallen based on diagnosis codes underestimates the true burden of falls. Individuals missed according to the code-based definition were less likely to have been admitted than those who were captured. These findings call attention to the value of using chief complaint information to identify individuals who have fallen in the ED—for research, clinical care, or policy reasons.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/jgs.14982

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