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Availability of pediatric emergency visit data from existing data sources
Marc H Gorelick1, Elizabeth R Alpern, Tasmeen Singh
1Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin and Children's Research Institute (MHG), Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA. mgorelic@mail.mcw.edu
Insights
Key pediatric emergency care data elements are often missing from administrative and clinical records, with significant variation across emergency departments (EDs). Researchers must account for these data gaps when planning studies.
Area of Science:
- Pediatric Emergency Medicine
- Health Informatics
- Data Management
Background:
- Emergency departments (EDs) are critical for pediatric care.
- Accurate data is essential for research and quality improvement in pediatric emergency medicine.
- Existing administrative and clinical data sources may have limitations in completeness and availability.
Purpose of the Study:
- To assess the availability and completeness of selected data elements from administrative and clinical sources for pediatric ED visits.
- To identify variations in data completeness across different sites within a national pediatric research network.
Main Methods:
- Retrospective study of 25 EDs in the Pediatric Emergency Care Applied Research Network (PECARN).
- Analysis of administrative data for all visits (2002) and abstracted medical record data for a sample of visits (2003).
- Data elements included epidemiologic, administrative, and clinical data for asthma and fracture cases.
Main Results:
- Data availability varied significantly by element, data source, and site.
- Administrative data for insurance type was most complete (1.3% missing), while triage time was least complete (65.3% missing).
- Medical record data for disposition (1.2% missing) and diagnosis (3% missing) were more complete than administrative sources (14.4% and 10.5% missing, respectively). E-codes were missing in 27% of injury cases.
Conclusions:
- Important data elements for pediatric emergency care are frequently absent in administrative and medical records.
- Significant variability exists in data completeness across different EDs.
- Researchers must be aware of these data limitations when designing pediatric emergency medicine studies.
Objectives:
To determine the availability and completeness of selected data elements from administrative and clinical sources for emergency department (ED) visits in a national pediatric research network.
Methods:
This was a retrospective study of 25 EDs in the Pediatric Emergency Care Applied Research Network. Data were obtained from two sources at each ED: 1) extant electronic administrative data for all visits during a 12-month period in 2002 and 2) data abstracted from medical records by trained abstractors for visits during ten randomly selected days over a three-month period in 2003. Epidemiologic data were obtained for all visits and additional clinical data for patients with two target conditions: asthma and fractures.
Results:
A total of 749,036 visits were analyzed from administrative sources and 12,756 medical records abstracted. Data availability varied by element, method of capture, and site. From administrative sources, data on insurance type were the most complete (1.3% overall missing; range, 0%-18.5% for individual sites), whereas mode of arrival (25.5% missing) and triage time (65.3%) were the least complete. Disposition was missing in only 1.2% of medical records overall (range, 0%-5%) and diagnosis was missing in 3% (range, 0%-16%); these were missing from 14.4% and 10.5%, respectively, of administrative sources. Among visits with injury diagnoses, E-codes were missing in 27% of cases. For patients with asthma (n = 861), documentation of specific elements of the clinical examination by nurses and physicians was also variable.
Conclusions:
Data elements important in emergency medical care for children are frequently missing in existing administrative and medical record sources; completeness varies widely across EDs. Researchers must be aware of these limitations in the use of existing data when planning studies.
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