Published online November 1, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. 1259-1260 (doi:10.1542/peds.2005-1605)
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Authors Incorrectly Cited Classification of Adverse-Event Codes

Jennifer A. Taylor, MPH
Department of Health Policy and Management
Center for Injury Research and Policy
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD 21205-1996

Marlene R. Miller, MD, MSc
Quality and Safety Initiatives and Departments of Pediatrics and Health Policy and Management
Johns Hopkins Childrens Center
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD 21287

To the Editor.—

The article by Woods and colleagues1 cited previous work by Slonim et al2 regarding their use of external-cause-of-injury (E) codes in assessing pediatric patient safety events. Slonim et al did use administrative data and codes from the International Classification of Diseases, Ninth Revision (ICD-9), but nature-of-injury (N) codes were used, not E-codes as described by Woods et al. The difference between E-codes and N-codes is that an N-code describes the nature of an injury (laceration, contusion, etc). If an N-code is applied by a medical-records coder, it should be followed by a supplemental code, an E-code, which describes the mechanism of the injury (motor vehicle crash, adverse medical event, etc). This is according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) official guidelines for coding and reporting.3

Slonim et al used N-codes 995.2 and 996–999, which indicate drug errors and complications of procedures and medical care. If E-codes with the same code numbers had been used (eg, E995–E999), that would have indicated injuries resulting from operations of war.4

E-codes are routinely used by injury-control researchers for surveillance. E-codes useful in the detection of patient safety events include E870–E876 (misadventures to patient during surgical and medical care), E878–E879 (surgical and medical procedures as the cause of abnormal reaction of patients or later complication, without mention of misadventure at the time of procedure), and E930–E949 (drugs, medicinal and biological substances causing adverse effects in therapeutic use).4

REFERENCES

  1. Woods D, Thomas E, Holl J, Altman S, Brennan T. Adverse events and preventable adverse events in children. Pediatrics. 2005;115 :155 –160[Abstract/Free Full Text]
  2. Slonim AD, LaFleur BJ, Ahmed W, Joseph JG. Hospital-reported medical errors in children. Pediatrics. 2003;111 :617 –621[Abstract/Free Full Text]
  3. Centers for Medicare and Medicaid Services and the National Center for Health Statistics. ICD-9-CM official guideline for coding and reporting. Available at: www.cdc.gov/nchs/data/icd9/icdguide.pdf. Accessed June 29, 2005
  4. Puckett C, ed. International Classification of Diseases, 9th Revision, Clinical Modification. Generic ICD-9-CM edition. Reno, NV: Channel Publishing, Ltd; 1999
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

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Authors Incorrectly Cited Classification of Adverse-Event Codes: In Reply
Donna M. Woods, Eric J. Thomas, Jane L. Holl, Stuart Altman, and Troyen Brennan
Pediatrics 2005 116: 1260. [Extract] [Full Text]  




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