PECARN members are listed in Appendix A.
Original Research Contribution
Developing a Diagnosis-based Severity Classification System for Use in Emergency Medical Services for Children
Version of Record online: 17 JAN 2012
© 2012 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 19, Issue 1, pages 70–78, January 2012
How to Cite
Alessandrini, E. A., Alpern, E. R., Chamberlain, J. M., Shea, J. A., Holubkov, R., Gorelick, M. H. and for the Pediatric Emergency Care Applied Research Network (2012), Developing a Diagnosis-based Severity Classification System for Use in Emergency Medical Services for Children. Academic Emergency Medicine, 19: 70–78. doi: 10.1111/j.1553-2712.2011.01250.x
Presented in part at the Pediatric Academic Societies Meetings, May 2007, Toronto, Ontario, Canada.
Funding was obtained through an HRSA Emergency Medical Services for Children (EMSC) Targeted Issues Grant (Grant H34MC02547) and The Pediatric Emergency Care Applied Research Network (PECARN) is supported by cooperative agreements U03MC00001, U03MC00003, U03MC00006, U03MC00007, and U03MC00008 from the EMSC program of the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services.
The authors have no further disclosures or conflicts of interest to report.
Supervising Editor: Lowell Gerson, PhD.
- Issue online: 17 JAN 2012
- Version of Record online: 17 JAN 2012
- Received May 4, 2011; revisions received July 2 and July 5, 2011; accepted July 6, 2011.
ACADEMIC EMERGENCY MEDICINE 2012; 19:70–78 © 2012 by the Society for Academic Emergency Medicine
Objectives: Lack of adequate risk adjustment methodologies has hindered the progress of emergency medicine health services research. The authors hypothesized that a consensus-derived, diagnosis-based severity classification system (SCS) would be significantly associated with actual measures of emergency department (ED) resource use and could ultimately be used to examine severity-adjusted outcomes across patient populations.
Methods: A panel of subject matter experts used consensus methods to assign severity scores (1 = lowest severity to 5 = highest severity) to 3,041 ED International Classifications of Diseases (ICD), 9th revision, diagnosis codes. SCS scores were assigned to ED visits using the visit diagnosis code with the highest severity. We tested the association between the SCS scores and measures of ED resource use in three data sets: the Pediatric Emergency Care Applied Research Network Core Data Project (PCDP), the National Hospital Ambulatory Medical Care Survey (NHAMCS), and the Connecticut state ED data set.
Results: There was a significant association between the five-level SCS and all six measures of resource use: triage category, disposition, ED resource use, Current Procedural Terminology Evaluation and Management (CPT E&M) codes, ED length of stay, and ED charges within the three ED data sets.
Conclusions: The SCS demonstrates validity in its strong association with actual ED resource use. The use of readily available ICD-9 diagnosis codes makes the SCS useful as a risk adjustment tool for health services research.