Head or skull injury? Consequences of using mistranslated ICD diagnosis category: Multicenter, blinded, randomized controlled analysis

Emergency care units in Hungary treat approximately 140–180 thousand head injuries of varying se'verity each year. These head injuries are mainly caused by traffic accidents, assaults, or domestic accidents. The outpatient care record contains details about the circumstances and underlying mechanisms of the head injury, the results of physical and imaging examinations, and therapeutic recommendations. The record also contains standardized codes for the diagnoses and the interventions performed, using the BNO (Betegségek Nemzetközi Osztályozása) classification, the Hungarian version of the international diagnostic classification system ICD (International Classification of Diseases). These records are important for financial reasons and for statistical purposes. The injury diagnoses consist of the ICD codes with the related diagnostic categories and in most cases also the corresponding Latin diagnoses describing the injuries sustained. The ICD categories often appear as Hungarian translations of the Latin diagnoses in the detailed Medical Diagnostic Reports on Injuries (MDRI). In Hungary, MDRI reports are prepared by physicians at the request of criminal prosecutors for forensic evaluation. In practice, however, MDRIs are usually based on the primary outpatient records. Head injuries are diagnosed using the codes in ICD Chapter 19, S00-S09. Translation errors may occur when ICD is adapted for different languages, resulting in different applications of certain diagnostic codes.

The present study investigates the use and frequency of the ICD-10 code S07.1 in Hungarian MDRIs issued for forensic evaluation. The results of our study show that, due to an inaccurate translation, superficial head injuries (specifically, bruises) are incorrectly coded in Hungary with S07.1, which in ICD-10 is reserved for severe head injuries (crushing injury of the skull).