Availability of pediatric emergency visit data from existing data sources.

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.