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American Journal of Epidemiology Vol. 148, No. 7: 666-667
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health

ORIGINAL CONTRIBUTIONS

Assessing Diagnostic Classification in an Emergency Department: Implications for Daily Time Series Studies of Air Pollution

David M. Stieb1, Robert C. Beveridge2, Brian H. Rowe3, Stephen D. Walter4 and Stan Judek1

1 Air Quality Health Effects Research Section, Health Canada Ottawa, Ontario, Canada.
2 Division of Emergency Medicine, Atlantic Health Sciences Corporation Saint John, New Brunswick, Canada
3 Division of Emergency Medicine, University of Alberta Edmonton, Alberta, Canada
4 Department of Clinical Epidemiology and Biostatistics, McMas-ter University Hamilton, Ontario, Canada

Received for publication August 28, 1997. Accepted for publication March 4, 1998.

Seven independent assessments of diagnosis were obtained for 92 records of nontrauma emergency department visits in Saint John, New Brunswick, Canada, in 1994. The hospital database was 1.18 times as likely (p < 0.05) as six external physician raters to classify visits as cardiorespiratory, which was consistent for high- and low-pollution days, Formula was 0.70 (95 percent confidence interval (Cl) 0.68–0.73). Formula, s were: asthma, 0.69 (95% Cl 0.64–0.73); chronic obstructive pulmonary disease, 0.78 (95% Cl 0.74–0.83); respiratory infections, 0.53 (95% Cl 0.49–0.57); cardiac, 0.84 (95% Cl 0.79–0.88); and other, 0.66 (95% Cl 0.62–0.71). Substantial or better interobserver agreement was seen, respiratory infections notwithstanding, and there was no evidence of diagnostic bias in relation to daily air pollution level. Am J Epidemiol 1998; 148: 666–70.

air pollution; bias (epidemiology); emergency service, hospital; heart diseases; lung diseases; observer variation


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