Development of the Canadian Emergency Department Diagnosis Shortlist.
OBJECTIVE
Managers of emergency departments (EDs), governments and researchers would benefit from reliable data sets that characterize use of EDs. Although Canadian ED lists for chief complaints and triage acuity exist, no such list exists for diagnosis classification. This study was aimed at developing a standardized Canadian Emergency Department Diagnosis Shortlist (CED-DxS), as a subset of the full International Classification of Diseases, 10th revision, with Canadian Enhancement (ICD-10-CA).


METHODS
Emergency physicians from across Canada participated in the revision of the ICD-10-CA through 2 rounds of the modified Delphi method. We randomly assigned chapters from the ICD-10-CA (approximately 3000 diagnoses) to reviewers, who rated the importance of including each diagnosis in the ED-specific diagnosis list. If 80% or more of the reviewers agreed on the importance of a diagnosis, it was retained for the final revision. The retained diagnoses were further aggregated and adjusted, thus creating the CED-DxS.


RESULTS
Of the 83 reviewers, 76% were emergency medicine (EM)-trained physicians with an average of 12 years of experience in EM, and 92% were affiliated with a university teaching hospital. The modified Delphi process and further adjustments resulted in the creation of the CED-DxS, containing 837 items. The chapter with the largest number of retained diagnoses was injury and poisoning (n = 292), followed by gastrointestinal (n = 59), musculoskeletal (n = 55) and infectious disease (n = 42). Chapters with the lowest number retained were neoplasm (n = 18) and pregnancy (n = 12).


CONCLUSIONS
We report the creation of the uniform CED-DxS, tailored for Canadian EDs. The addition of ED diagnoses to existing standardized parameters for the ED will contribute to homogeneity of data across the country.
Unger
Bernard
B
Emergency Multidisciplinary Research Unit, Jewish General Hospital, McGill University, 3755 Cote Ste. Catherine Rd., Montréal QC, Canada. bernard.unger@mcgill.ca
Afilalo
Marc
M
Boivin
Jean François
JF
Bullard
Michael
M
Grafstein
Eric
E
Schull
Michael
M
Lang
Eddy
E
Colacone
Antoinette
A
Soucy
Nathalie
N
Xue
Xiaoqing
X
Segal
Eli
E
D002170:Canada; D003697:Delphi Technique; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D038801:International Classification of Diseases / Q000458:organization & administration* / Q000592:standards