{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T12:47:28Z","timestamp":1785934048433,"version":"3.56.0"},"reference-count":25,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,8]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine the rate of coding-based discrepancies between admission and discharge diagnoses in hospitalised paediatric patients in China, identify associated factors and investigate the impact on length of stay (LOS) and total hospitalisation expenses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>30 tertiary children\u2019s hospitals across seven geographical regions of China, 2016\u20132021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>7\u2009575\u2009622 hospitalisation records aged under 19 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Primary outcome: proportion of hospitalisations with inconsistent admission and discharge diagnoses (defined by International Classification of Diseases-10 code mismatch). Secondary outcomes: LOS and total hospitalisation expenses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>2\u2009040\u2009457 records (26.93%) had inconsistent diagnosis code, with a significant increasing trend over time (Cochran-Armitage Z=137.95, p&lt;0.001). Higher odds of coding inconsistency were associated with adolescents aged 13\u201318 years (OR 1.216, 95%\u2009CI 1.198 to 1.233), emergency department admission (OR 1.115, 95%\u2009CI 1.110 to 1.120), greater comorbidity burden (OR 1.178, 95%\u2009CI 1.177 to 1.179 per additional comorbidity) and hospital location in Middle China (OR 1.688, 95%\u2009CI 1.675 to 1.700). Coding inconsistency rates were highest for infectious and parasitic diseases (45.06%) and circulatory system diseases (41.25%). After adjustment for potential confounders, diagnostic inconsistency was independently associated with longer LOS (\u03b2=0.082, p&lt;0.001) and higher total expenses (\u03b2=0.058, p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings highlight opportunities to enhance coding accuracy and optimise clinical workflows in paediatric healthcare in China. Enhancing diagnostic consistency can optimise resource utilisation, reduce costs and improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-117168","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:55:29Z","timestamp":1785930929000},"page":"e117168","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Coding-based discrepancies between admission and discharge diagnoses of paediatric patients in China: an observational study of more than 7 million hospitalisation records"],"prefix":"10.1136","volume":"16","author":[{"given":"Yidi","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5377-0816","authenticated-orcid":false,"given":"Xinyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Big Data Center, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Xu","sequence":"additional","affiliation":[{"name":"Big Data Center, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1998-2951","authenticated-orcid":false,"given":"Guoshuang","family":"Feng","sequence":"additional","affiliation":[{"name":"Big Data Center, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Ni","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"2026080504551597000_16.8.e117168.1","first-page":"2348","article-title":"Discrepancy between Admission and Discharge Diagnoses in Central Serbia: Analysis by the Groups of International Classification of Diseases, 10th Revision","volume":"49","author":"Mihailovic","year":"2020","journal-title":"Iran J Public Health"},{"key":"2026080504551597000_16.8.e117168.2","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1097\/MEJ.0b013e32834ce104","article-title":"Accuracy of prehospital diagnoses by emergency physicians: comparison with discharge diagnosis","volume":"19","author":"Heuer","year":"2012","journal-title":"Eur J Emerg Med"},{"key":"2026080504551597000_16.8.e117168.3","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000221538.00856.b9"},{"key":"2026080504551597000_16.8.e117168.4","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1001\/jamainternmed.2013.2777","article-title":"Types and origins of diagnostic errors in primary care settings","volume":"173","author":"Singh","year":"2013","journal-title":"JAMA Intern Med"},{"key":"2026080504551597000_16.8.e117168.5","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1177\/102490790200900203","article-title":"Study on the Discrepancies between the Admitting Diagnoses from the Emergency Department and the Discharge Diagnoses","volume":"9","author":"Lim","year":"2002","journal-title":"Hong Kong Journal of Emergency Medicine"},{"key":"2026080504551597000_16.8.e117168.6","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-197809000-00004"},{"key":"2026080504551597000_16.8.e117168.7","doi-asserted-by":"publisher","DOI":"10.1590\/1516-3180.0471.R1.05032020"},{"key":"2026080504551597000_16.8.e117168.8","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/QMH.0b013e31826d1ed2","article-title":"Cost and quality implications of discrepancies between admitting and discharge diagnoses","volume":"21","author":"McNutt","year":"2012","journal-title":"Qual Manag Health Care"},{"key":"2026080504551597000_16.8.e117168.9","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.453"},{"key":"2026080504551597000_16.8.e117168.10","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-019-2475-9","article-title":"In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission","volume":"23","author":"Abe","year":"2019","journal-title":"Crit Care"},{"key":"2026080504551597000_16.8.e117168.11","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1515\/dx-2021-0001","article-title":"Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality","volume":"9","author":"Bastakoti","year":"2021","journal-title":"Diagnosis (Berl)"},{"key":"2026080504551597000_16.8.e117168.12","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1177\/102490790301000202","article-title":"A Comparison of Emergency Department Admission Diagnoses and Discharge Diagnoses: Retrospective Study","volume":"10","author":"Chiu","year":"2003","journal-title":"Hong Kong j Emerg Med"},{"key":"2026080504551597000_16.8.e117168.13","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2020-045948D","article-title":"Diagnostic Error in Pediatrics: A Narrative Review","volume":"149","author":"Marshall","year":"2022","journal-title":"Pediatrics"},{"key":"2026080504551597000_16.8.e117168.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-023-03995-2","article-title":"Diagnostic consistency between admission and discharge of pediatric cases in a tertiary teaching hospital in China","volume":"23","author":"Zhang","year":"2023","journal-title":"BMC Pediatr"},{"key":"2026080504551597000_16.8.e117168.15","doi-asserted-by":"publisher","DOI":"10.1002\/ped4.12297"},{"key":"2026080504551597000_16.8.e117168.16","first-page":"1141","article-title":"An epidemiological analysis on external causes of morbidity and mortality for hospitalized children in 22 grade III (A) children\u2019s hospitals","volume":"35","author":"Wang","year":"2020","journal-title":"Disease Surveillance"},{"key":"2026080504551597000_16.8.e117168.17","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.2298\/VSP150427057M","article-title":"Agreement between admission and discharge diagnoses: Analysis by the groups of international classification of diseases, 10th revision","volume":"73","author":"Mihailovi\u0107","year":"2016","journal-title":"Vojnosanit Pregl"},{"key":"2026080504551597000_16.8.e117168.18","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0253316","article-title":"The discrepancy between admission and discharge diagnoses: Underlying factors and potential clinical outcomes in a low socioeconomic country","volume":"16","author":"Fatima","year":"2021","journal-title":"PLoS One"},{"key":"2026080504551597000_16.8.e117168.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2018.04.028"},{"key":"2026080504551597000_16.8.e117168.20","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2021.686904","article-title":"Recall Accuracy in Children: Age vs. Conceptual Thinking","volume":"12","author":"Murnikov","year":"2021","journal-title":"Front Psychol"},{"key":"2026080504551597000_16.8.e117168.21","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1515\/dx-2015-0028","article-title":"Disagreement between emergency department admission diagnosis and hospital discharge diagnosis: mortality and morbidity","volume":"3","author":"Eames","year":"2016","journal-title":"Diagnosis (Berl)"},{"key":"2026080504551597000_16.8.e117168.22","first-page":"1177","article-title":"Evaluation of diagnostic accuracy in the clinical setting","volume":"23","author":"Raz","year":"1987","journal-title":"Isr J Med Sci"},{"key":"2026080504551597000_16.8.e117168.23","doi-asserted-by":"crossref","DOI":"10.1186\/s13049-019-0629-z","article-title":"Diagnostic error increases mortality and length of hospital stay in patients presenting through the emergency room","volume":"27","author":"Hautz","year":"2019","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"2026080504551597000_16.8.e117168.24","doi-asserted-by":"publisher","DOI":"10.1111\/jep.13020"},{"key":"2026080504551597000_16.8.e117168.25","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2005.00444.x"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-117168","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:55:33Z","timestamp":1785930933000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-117168"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":25,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,5]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bmjopen-2026-117168"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-117168","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}