Congruence of disposition after emergency department intubation in the National Hospital Ambulatory Medical Care Survey.

Abstract

The National Hospital Ambulatory Medical Care Survey (NHAMCS) includes a large nationally representative sample of emergency department (ED) visits that is widely used for research. This study investigates the frequency of apparent NHAMCS disposition discrepancies for visits with intubation. Using 10 years' worth of NHAMCS data composed of 348,367 ED visits, those recorded as including intubation were evaluated for congruence of disposition, which was expected to be either death or admission to a critical care unit. Of the 875 ED patients recorded as having intubation performed, 27% had incompatible dispositions: 81 (9%) were recorded as discharged and 153 (17%) as admitted to a non-critical care unit. Cross-reference with free text chief complaint descriptions and International Classification of Diseases, Ninth Revision diagnoses codes indicated errors in recording both intubation and admission. One fourth of NHAMCS ED visits with intubation have an ED disposition incompatible with this procedure.