Accuracy of laceration length estimation in a pediatric emergency department and its impact on billing practices.
OBJECTIVE
This study aimed to determine the accuracy of laceration length estimation in a pediatric emergency department among health care providers of varying levels of training and its impact on billing practices.


METHODS
This study involves a prospective case series. Children younger than 21 years with lacerations evaluated and repaired in the pediatric emergency department between January 1 and April 30, 2012, were eligible for enrollment. Each laceration was evaluated by a trainee/midlevel provider (frontline provider) and by an attending physician; each one offered an estimated laceration length. The true measurement was then documented by 1 of 6 pediatric emergency medicine fellows on shift. Data were analyzed using descriptive statistics. The mean error of estimation (the absolute differences between the estimated and the true laceration length) of attending physicians and frontline providers were determined and compared. The proportions of lacerations whose estimated length was in a different billing category were compared using χ(2). Cost analysis was documented.


RESULTS
One hundred ninety patients were enrolled. The mean age was 5.9 years. A total of 119 patients (62.6%) were male, and 134 lacerations (70.5%) were located on the face. Most repairs were simple (79%). There was no difference between the estimated and measured length among attendings and frontline providers (P = 0.583). An average of 8.2% of lacerations were misclassified and billed incorrectly with 20% (4/20) of facial lacerations up-coded. The mean overcharge was $12.04. Of 11 lacerations elsewhere on the body, 3 (27%) were down-coded, with an average difference of $6.97 for simple and $38.51 for layered repairs.


CONCLUSIONS
Pediatric emergency medicine practitioners are accurate estimators of laceration length. Eight percent of lacerations are misclassified and billed incorrectly. Physicians should be required to report measured lengths for billing.
From the *Miami Children's Hospital and †Herbert Wertheim College of Medicine, Florida International University, Modesto Maidique Campus, Miami, FL.
Laura
L
Umbrello
Vincenzo
V
Maniaci
Barbara M
BM
Garcia Peña
Juan Manuel
JM
Lozano
Marla
M
Friedman
D000293:Adolescent; D000886:Anthropometry; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D039702:Current Procedural Terminology; D004636:Emergency Service, Hospital / Q000191:economics; D005151:Facial Injuries / Q000145:classification / Q000191:economics / Q000473:pathology; D005257:Fellowships and Scholarships; D005260:Female; D006282:Health Personnel / Q000191:economics / Q000523:psychology; D006801:Humans; D007223:Infant; D007396:Internship and Residency; D022125:Lacerations / Q000145:classification / Q000191:economics / Q000473:pathology*; D008297:Male; D008505:Medical Staff, Hospital / Q000191:economics / Q000523:psychology; D009722:Nurse Practitioners / Q000191:economics / Q000523:psychology; D015588:Observer Variation; D010823:Physician Assistants / Q000191:economics / Q000523:psychology; D011446:Prospective Studies; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D058106:Wound Closure Techniques / Q000191:economics; D055815:Young Adult