{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T23:42:43Z","timestamp":1788824563056,"version":"build-2803163510"},"reference-count":50,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T00:00:00Z","timestamp":1654473600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["T32 AG051090"],"award-info":[{"award-number":["T32 AG051090"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To characterize and validate the landscape of algorithms that use International Classification of Disease (ICD) codes to identify low\u2010acuity emergency department (ED) visits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources<\/jats:title><jats:p>Publicly available ED data from the National Hospital Ambulatory Medical Care Survey (NHAMCS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>We systematically searched for studies that specify algorithms consisting of ICD codes that identify preventable or low\u2010acuity ED visits. We classified ED visits in NHAMCS according to these algorithms and compared agreements using the Jaccard index. We then evaluated the performance of each algorithm using positive predictive value (PPV) and sensitivity, with the reference group specified using low\u2010acuity composite (LAC) criteria consisting of both triage and clinical components. In sensitivity analyses, we repeated our primary analysis using only triage or only clinical criteria for reference.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection<\/jats:title><jats:p>We used the 2011\u20132017 NHAMCS data, totaling 163,576 observations before survey weighting and after dropping observations missing a primary diagnosis. We translated ICD\u20109 codes (years 2011\u20132015) to ICD\u201010 using a standard crosswalk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>We identified 15 papers with an original list of ICD codes used to identify preventable or low\u2010acuity ED presentations. These papers were published between 1992 and 2020, cited an average of 310 (SD 360) times, and included 968 (SD 1175) codes. Pairwise Jaccard similarity indices (0\u00a0=\u00a0no overlap, 1\u00a0=\u00a0perfect congruence) ranged from 0.01 to 0.82, with mean 0.20 (SD 0.13). When validated against the LAC reference group, the algorithms had an average PPV of 0.308 (95% CI [0.253, 0.364]) and sensitivity of 0.183 (95% CI [0.111, 0.256]). Overall, 2.1% of visits identified as low acuity by the algorithms died prehospital or in the ED, or needed surgery, critical care, or cardiac catheterization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Existing algorithms that identify low\u2010acuity ED visits lack congruence and are imperfect predictors of visit acuity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.14011","type":"journal-article","created":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T05:19:36Z","timestamp":1653628776000},"page":"979-989","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Algorithms identifying low\u2010acuity emergency department visits: A review and validation study"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8418-1835","authenticated-orcid":false,"given":"Angela T.","family":"Chen","sequence":"first","affiliation":[{"name":"Health Care Management Department, The Wharton School University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Leonard Davis Institute of Health Economics University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhavi","family":"Muralidharan","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ari B.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Leonard Davis Institute of Health Economics University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,6,6]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"Trends in Hospital Emergency Department Visits by Age and Payer, 2006\u20132015: Statistical Brief #238","author":"Sun R","year":"2018"},{"issue":"5","key":"e_1_2_8_3_1","first-page":"491","article-title":"Nonurgent use of hospital emergency departments: urgency from the patient's perspective","volume":"42","author":"Gill JM","year":"1996","journal-title":"J Fam Pract"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000000392"},{"issue":"1","key":"e_1_2_8_5_1","first-page":"47","article-title":"Emergency department visits for nonurgent conditions: systematic literature review","volume":"19","author":"Uscher\u2010Pines L","year":"2013","journal-title":"Am J Manag Care"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2006.06.027"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2018-008820"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2009.0748"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-018-3270-4"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.828"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.1541"},{"key":"e_1_2_8_12_1","unstructured":"AbelsonR.Outcry Forces UnitedHealthcare to Delay Plan to Deny Coverage for Some E.R. 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