[Quality of emergency diagnosis of lesions of external causes requiring hospitalization]

To establish the quality of emergency department diagnoses for those patients whose injuries required hospital admission.

Emergency and hospital discharge diagnostics were retrieved for 339 injured patients. Severity scores (ISS) were calculated using an automatic conversion procedure (ICDMAP). Emergency diagnoses for each patient (grouped into categories) were compared with the hospital discharge ones. Quality was analyzed based on accuracy (Percy groups) and reliability (percentage of concordance) measurements. Severity scores were evaluated using reliability measures (percentage of concordance and intraclass correlation coefficient-ICC-).

Mean diagnoses per patient were 1.1 at the emergency department and 1.4 at hospital discharge. In the latter, there were diagnoses in each category except for those more unspecific, where there was a reduction. Overall, emergency information showed under notification. Severity scores were higher with hospital discharge data. There was a 63% percentage of concordance. When grouped into categories, severity scores had an ICC of 0.61 (moderate-good).

Emergency departments are a potential good source of information about injury severity even for those patients who require hospital admission. Emergency department injury surveillance can be very useful in assessing the magnitude and distribution of injury severity at the population level. Nevertheless for individual severity assessment, use of hospital discharge information is recommended.