Table 2.
Concordance between the primary diagnosis code assigned in the ED and the primary diagnosis code assigned at hospital discharge following an ED visit for any mental health conditions or SUDs (n=16 926, 48 116 pairs)
| Health conditions | Condition indicated in | Concordance statistics | Validity statistics (assume hospital discharge diagnosis as ‘gold standard’) |
|||||||||
| Any N (%) |
ED only N (%) |
Hospital only N (%) |
ED and hospital N (%) |
Overall agree | Positive agree | Negative agree | Kappa (95% CI) |
Sensitivity (95% CI) |
Specificity (95% CI) |
Positive predictive value (95% CI) | Negative predictive value (95% CI) | |
| Mental health and substance use disorders | 17 520 (36.4) | 1040 (2.2) | 4275 (8.9) | 12 205 (25.4) | 0.89 | 0.82 | 0.92 | 0.74 (0.74 to 0.75) | 0.74 (0.73 to 0.75) | 0.97 (0.97 to 0.97) | 0.92 (0.92 to 0.93) | 0.88 (0.87 to 0.88) |
| Any selected SUDs | 6299 (13.1) | 639 (1.3) | 4492 (9.3) | 1168 (2.4) | 0.89 | 0.31 | 0.94 | 0.27 (0.26 to 0.28) | 0.21 (0.20 to 0.22) | 0.99 (0.98 to 0.99) | 0.65 (0.62 to 0.67) | 0.90 (0.90 to 0.91) |
| Alcohol use disorders | 604 (1.3) | 90 (0.2) | 452 (0.9) | 62 (0.1) | 0.97 | 0.48 | 0.98 | 0.47 (0.44 to 0.49) | 0.38 (0.35 to 0.40) | 0.99 (0.99 to 0.99) | 0.67 (0.64 to 0.70) | 0.97 (0.97 to 0.98) |
| Other SUDs* | 2314 (4.8) | 359 (0.7) | 1222 (2.5) | 733 (1.5) | 0.92 | 0.17 | 0.96 | 0.15 (0.14 to 0.17) | 0.10 (0.09 to 0.11) | 0.99 (0.99 to 0.99) | 0.54 (0.50 to 0.58) | 0.93 (0.93 to 0.93) |
| Opioid use disorder | 4035 (8.4) | 330 (0.7) | 3320 (6.9) | 385 (0.8) | 0.99 | 0.19 | 0.99 | 0.18 (0.14 to 0.22) | 0.12 (0.09 to 0.15) | 1.00 (1.00 to 1.00) | 0.41 (0.33 to 0.49) | 0.99 (0.99 to 0.99) |
| Any selected mental health disorders | 13 226 (27.5) | 2644 (5.5) | 2761 (5.7) | 7821 (16.3) | 0.89 | 0.74 | 0.93 | 0.67 (0.66 to 0.68) | 0.74 (0.73 to 0.75) | 0.93 (0.93 to 0.93) | 0.75 (0.74 to 0.76) | 0.93 (0.92 to 0.93) |
| Mood disorders† | 2070 (4.3) | 874 (1.8) | 775 (1.6) | 421 (0.9) | 0.95 | 0.43 | 0.97 | 0.40 (0.39 to 0.42) | 0.39 (0.37 to 0.41) | 0.98 (0.98 to 0.98) | 0.48 (0.46 to 0.51) | 0.97 (0.97 to 0.97) |
| Depression | 157 (0.3) | 71 (0.1) | 73 (0.2) | 13 (0.0) | 0.97 | 0.34 | 0.98 | 0.32 (0.30 to 0.34) | 0.35 (0.32 to 0.38) | 0.98 (0.98 to 0.98) | 0.33 (0.30 to 0.35) | 0.98 (0.98 to 0.98) |
| Psychoses | 582 (1.2) | 104 (0.2) | 433 (0.9) | 45 (0.1) | 0.92 | 0.72 | 0.95 | 0.67 (0.66 to 0.68) | 0.78 (0.77 to 0.79) | 0.94 (0.94 to 0.94) | 0.67 (0.66 to 0.68) | 0.96 (0.96 to 0.97) |
| Neurotic/stress/somatoform disorders‡ | 9323 (19.4) | 2592 (5.4) | 1459 (3.0) | 5272 (11.0) | 0.97 | 0.13 | 0.99 | 0.11 (0.09 to 0.14) | 0.10 (0.08 to 0.12) | 0.99 (0.99 to 0.99) | 0.18 (0.15 to 0.22) | 0.98 (0.98 to 0.98) |
| Anxiety disorders | 3468 (7.2) | 1015 (2.1) | 1500 (3.1) | 953 (2.0) | 1.00 | 0.15 | 1.00 | 0.15 (0.08 to 0.23) | 0.15 (0.08 to 0.24) | 1.00 (1.00 to 1.00) | 0.16 (0.09 to 0.25) | 1.00 (1.00 to 1.00) |
| Personality disorders | 1316 (2.7) | 396 (0.8) | 832 (1.7) | 88 (0.2) | 0.99 | 0.14 | 0.99 | 0.14 (0.10 to 0.18) | 0.09 (0.07 to 0.12) | 1.00 (1.00 to 1.00) | 0.30 (0.23 to 0.38) | 0.99 (0.99 to 0.99) |
*Included opioid use disorder.
†Included depression.
‡Included anxiety disorders.
ED, emergency department; SUD, substance use disorder.