Research Article| Volume 51, ISSUE 10, P2230-2234, October 2020

Validating injury-related diagnoses by physicians: an analysis of 62,269 hospitalizations from a large hospital in Changsha, China


      • Physicians’ diagnoses only reported 405 (40%) of the 1011 injury-related hospitalizations.
      • The proportions of under-reporting, lack of cause specificity, and misclassification errors were 50.5%, 7.9% and 1.5%, respectively.
      • The proportion of diagnostic errors remained relatively similar across patient sex, intent of injury, and cause of injury subgroups, but varied substantially across patient age groups.



      To assess the accuracy of injury-related hospitalization diagnoses by physicians in China.


      62,269 hospitalizations between 2014 and 2016 at a large hospital in Changsha, China were assessed. We considered three types of diagnostic errors: under-reporting, lack of cause specificity, and misclassification across injury causes. Diagnosis and coding of diseases were ascertained by professional coders based on the tenth International Classification of Disease (ICD-10). Chi square tests examined the proportion difference across subgroups of patient demographics, injury intent, and injury cause.


      The 62,269 records included 1011 injury-induced hospitalizations, but physicians’ diagnoses only reported 405 (40%) of the 1011 hospitalizations as injury-related. The proportions of under-reporting, lack of cause specificity, and misclassification errors, respectively, were 50.5%, 7.9% and 1.5%. The proportion of diagnostic errors was relatively similar across patient sex, intent of injury, and cause of injury subgroups, but varied substantially across patient age groups.


      Physicians’ diagnoses frequently omitted injury-induced hospitalizations. Such errors will impact injury research and policy-making when they are undetected and uncorrected.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • O'Malley KJ
        • Cook KF
        • Price MD
        • et al.
        Measuring diagnoses: ICD code accuracy.
        Health Serv Res. 2005; 40: 1620-1639
        • Wu YC.
        Reason analysis on filling defects of principal diagnosis and relevant countermeasure.
        Chin Med Rec. 2014; 15 (In Chinese): 27-28
        • Farzandipour M
        • Sheikhtaheri A
        • Sadoughi F
        Effective factors on accuracy of principal diagnosis coding based on international classification of diseases, the 10th revision (ICD-10).
        Int J Inf Manag. 2010; 30: 0-84
        • Januel JM
        • Luthi JC
        • Quan H
        • et al.
        Improved accuracy of co-morbidity coding over time after the introduction of ICD-10 administrative data.
        BMC Health Serv Res. 2011 Aug 18; 11: 194
        • Barker-Collo S
        • Theadom A
        • Jones K
        • et al.
        Accuracy of an international classification of diseases code surveillance system in the identification of traumatic brain injury.
        Neuroepidemiology. 2016; 47: 46-52
        • McKenzie K
        • McClure RJ.
        Sources of coding discrepancies in injury morbidity data: implications for injury surveillance.
        Int J Inj Contr Saf Promot. 2010; 17: 53-60
        • Davie G
        • Langley J
        • Samaranayaka A
        • et al.
        Accuracy of injury coding under ICD-10-AM for New Zealand public hospital discharges.
        Inj Prev. 2008; 14: 319-323
        • Bergström MF
        • Byberg L
        • Melhus H
        • et al.
        Extent and consequences of misclassified injury diagnoses in a national hospital discharge registry.
        Inj Prev. 2011; 17: 108-113
        • Tang RH
        • Lu XX
        • Dai CX
        Analysis on problems of existing in the coding of external causes of disease and death.
        Chin Med Rec. 2014; 15 (In Chinese): 30-31
        • GBD, Disease and injury incidence and prevalence collaborators
        Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global burden of disease study 2015.
        Lancet. 2016; 388: 1545-1602
        • World Health Organization
        International statistical classification of diseases and related health problems (Vol. 1).
        (10th ed). WHO, Geneva1994
      1. External cause of injury mortality matrix for ICD-10 [EB/OL]. Centers for disease control and prevention in US. 2002.10.

        • Zhou YL.
        Current status and factors that influence diagnostic errors in the recording of medical records by house surgeon.
        Sichuan J Anat. 2019; 27 (156. In Chinese): 150-152
        • Lv JB
        • Lv L.
        Investigation on status quo of medical record management department in 45 tertiary hospitals in Hebei Province.
        Chin Hosp. 2014; 18 (In Chinese): 14-16
        • Wang XL
        • Li X
        • Su JJ
        • et al.
        Investigation on the current situation of the medical records department of 43 hospitals in Liuzhou City.
        Chin Med Rec. 2019; 20 (In Chinese): 3-6
      2. Chinese Medical Doctor Association. Chinese physician practice situation white paper. Available online: (accessed on 22 May 2018).

        • Fu Y
        • Schwebel DC
        • Hu G
        Physicians' workloads in China: 1998-2016.
        Int J Environ Res Public Health. 2018; 15: 1649
        • Gao YY
        • Li L
        • Schwebel DC
        • et al.
        Reimbursement for injury-induced medical expenses in Chinese social medical insurance schemes: a systematic analysis of legislative documents.
        Plos One. 2018; 13e0194381
        • Tian JX.
        Influencing factors and countermeasures for accurate external cause coding of injuries and poisonings.
        Chin Med Rec. 2004; 5 (In Chinese): 33-34
        • Heinänen M
        • Brinck T
        • Handolin L
        • et al.
        Accuracy and coverage of diagnosis and procedural coding of severely injured patients in the Finnish hospital discharge register: comparison to patient files and the Helsinki trauma registry.
        Scan J Surg. 2017; 106: 269-277
        • Ning P
        • Schwebel DC
        • Chu H
        • et al.
        Changes in reporting for unintentional injury deaths, United States of America.
        Bull World Health Organ. 2019; 97: 190-199