Observational studyBMJ open2026
Coding-based discrepancies between admission and discharge diagnoses of paediatric patients in China: an observational study of more than 7 million hospitalisation records.
Observational study in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
objectivesTo 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.
designRetrospective observational study.
setting30 tertiary children's hospitals across seven geographical regions of China, 2016-2021.
participants7 575 622 hospitalisation records aged under 19 years. PRIMARY AND SECONDARY OUTCOME MEASURES: 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.
results2 040 457 records (26.93%) had inconsistent diagnosis code, with a significant increasing trend over time (Cochran-Armitage Z=137.95, p<0.001). Higher odds of coding inconsistency were associated with adolescents aged 13-18 years (OR 1.216, 95% CI 1.198 to 1.233), emergency department admission (OR 1.115, 95% CI 1.110 to 1.120), greater comorbidity burden (OR 1.178, 95% CI 1.177 to 1.179 per additional comorbidity) and hospital location in Middle China (OR 1.688, 95% CI 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 (β=0.082, p<0.001) and higher total expenses (β=0.058, p<0.001).
conclusionsThese 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.
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