Differences between recorded diagnoses of patients of an emergency department and office-hours primary care doctors: a register-based study in a Finnish town

Figures & data

Table 1. One hundred most commonly recorded diagnoses in the ED. ICD-10 codes, numbers of cases and percentage of recorded diagnoses are presented

Diagnosis	ICD-10	N	%	Diagnosis	ICD-10	N	%
Acute upper respiratory infections of multiple and unspecified sites	J06	20,381	5,8	Syncope and collapse	R55	1549	0,4
Abdominal and pelvic pain	R10	16,843	4,8	Pain, not elsewhere classified	R52	1543	0,4
Suppurative and unspecified otitis media	H66	15,717	4,5	Otitis externa	H60	1532	0,4
Dorsalgia	M54	13,845	4,0	Haemorrhage from respiratory passages	R04	1526	0,4
Open wound of head	S01	9401	2,7	Convulsions, not elsewhere classified	R56	1500	0,4
Acute bronchitis	J20	9306	2,7	Urticaria	L50	1497	0,4
Other gastroenteritis and colitis of infectious and unspecified origin	A09	6917	2,0	Shoulder lesions	M75	1462	0,4
Mental and behavioural disorder due to use of alcohol	F10	6879	2,0	Acute tubulo-interstitial nephritis	N10	1457	0,4
Pain in throat and chest	R07	6520	1,9	Dislocation, sprain and strain of joints and ligaments of knee	S83	1436	0,4
Dislocation, sprain and strain of joints and ligaments at ankle and foot level	S93	6160	1,8	Dislocation, sprain and strain of joints and ligaments of shoulder girdle	S43	1430	0,4
Open wound of wrist and hand	S61	5927	1,7	Viral and other specified intestinal infections	A08	1401	0,4
Cystitis	N30	5919	1,7	Cellulitis	L03	1398	0,4
Acute tonsillitis	J03	5785	1,7	Other dorsopathies, not elsewhere classified	M53	1393	0,4
Conjunctivitis	H10	5499	1,6	Atopic dermatitis	S20	1371	0,4
Acute sinusitis	J01	5375	1,5	Other headache syndromes	G44	1358	0,4
Other soft tissue disorders, not elsewhere classified	M79	4508	1,3	Atrial fibrillation and flutter	I48	1260	0,4
Intracranial injury	S06	4240	1,2	Superficial injury of lower leg	S81	1206	0,3
Malaise and fatigue	R53	4078	1,2	Problems related to lifestyle	Z72	1160	0,3
Abnormalities of breathing	R06	3694	1,1	Other functional intestinal disorders	K59	1147	0,3
Fracture of forearm	S52	3672	1,0	Disorders of vestibular function	H81	1135	0,3
Nonsuppurative otitis media	H65	3605	1,0	Fracture of rib(s), sternum and thoracic spine	S22	1085	0,3
Dizziness and giddiness	R42	3516	1,0	Foreign body on external eye	T15	1066	0,3
Urinary tract infection, site not specified	N39	3475	1,0	Heart failure	I50	996	0,3
Pneumonia, organism unspecified	J18	3361	1,0	Angina pectoris	I20	992	0,3
Headache	R51	3221	0,9	Epilepsy	G40	980	0,3
Depressive episode	F32	3062	0,9	Schizophrenia	F20	939	0,3
Fracture at wrist and hand level	S62	3055	0,9	Open wound of ankle and foot	S91	936	0,3
Maltreatment syndromes	T74	2888	0,8	Dyspepsia	K30	923	0,3
Superficial injury of wrist and hand	S60	2768	0,8	Tachycardia, unspecified	R00	914	0,3
Acute laryngitis and tracheitis	J04	2760	0,8	Reaction to severe stress, and adjustment disorders	F43	913	0,3
Erysipelas	A46	2669	0,8	Calculus of kidney and ureter	N20	893	0,3
Acute pharyngitis	J02	2630	0,8	Internal derangement of knee	M23	889	0,3
Fever of other and unknown origin	R50	2615	0,7	Superficial injury of forearm	S50	851	0,2
Other anxiety disorders	F41	2605	0,7	Phlebitis and thrombophlebitis	I80	843	0,2
Dislocation of finger	S63	2292	0,7	Open wound of forearm	S51	813	0,2
Fracture of lower leg, including ankle	S82	2193	0,6	Delirium, not induced by alcohol and other psychoactive substances	F05	811	0,2
Asthma	J45	2024	0,6	Superficial injury of abdomen, lower back and pelvis	S30	799	0,2
Fracture of shoulder and upper arm	S42	2009	0,6	Otalgia and effusion of ear	H92	790	0,2
Migraine	G43	1919	0,5	Other disorders of fluid, electrolyte and acid-base balance	E87	767	0,2
Superficial injury of lower leg	S80	1876	0,5	Oedema, not elsewhere classified	R60	751	0,2
Nausea and vomiting	R11	1816	0,5	Diverticular disease of small intestine with perforation and abscess	K57	742	0,2
Adverse effects, not elsewhere classified	T78	1795	0,5	Chronic obstructive pulmonary disease with acute lower respiratory infection	J44	718	0,2
Superficial injury of ankle and foo	S90	1770	0,5	Keratitis	H16	692	0,2
Fracture of foot, except ankle	S92	1740	0,5	Injury of Achilles tendon	S86	686	0,2
Other cardiac arrhythmias	I49	1676	0,5	Dislocation, sprain and strain of joints and ligaments at neck level	S13	684	0,2
Essential (primary) hypertension	I10	1668	0,5	Cholelithiasis	K80	669	0,2
Superficial injury of head	S00	1594	0,5	Other enthesopathies	M77	665	0,2
Cutaneous abscess, furuncle and carbuncle of face	L02	1586	0,5	Haemorrhoids	I84	662	0,2
Influenza with pneumonia, virus not identified	J11	1583	0,5	Bacterial pneumonia, not elsewhere classified	J15	662	0,2
Cough	R05	1559	0,4	Superficial injury of shoulder and upper arm	S40	658	0,2

Table 2. One hundred most commonly recorded diagnoses in office-hours GPs’ practices. ICD-10 codes, numbers of cases and percentage of recorded diagnoses are presented

Diagnosis	ICD-10	N	%	Diagnosis	ICD-10	N	%
Acute upper respiratory infections of multiple and unspecified sites	J06	142,039	9,3	Haemorrhoids	I84	6205	0,4
Dorsalgia	M54	81,174	5,3	Fever of other and unknown origin	R50	6119	0,4
Suppurative and unspecified otitis media	H66	60,288	3,9	Malaise and fatigue	R53	6030	0,4
Acute sinusitis	J01	50,089	3,3	Medical observation and evaluation for suspected diseases and conditions	Z03	5847	0,4
Acute bronchitis	J20	48,219	3,2	Cystitis	N30	5738	0,4
Essential (primary) hypertension	I10	47,373	3,1	Other functional intestinal disorders	K59	5572	0,4
Abdominal and pelvic pain	R10	34,660	2,3	Localised swelling, mass and lump of skin and subcutaneous tissue	R22	5489	0,4
Non-insulin-dependent diabetes mellitus	E11	32,740	2,1	Other cardiac arrhythmias	I49	5217	0,3
Conjunctivitis	H10	32,406	2,1	Seborrhoeic keratosis	L82	5209	0,3
Depressive episode	F32	27,040	1,8	Dyspepsia	K30	5079	0,3
Other soft tissue disorders, not elsewhere classified	M79	25,877	1,7	Examination and observation for unspecified reason	Z04	4926	0,3
Gonarthrosis [arthrosis of knee]	M17	23,721	1,6	Synovitis and tenosynovitis	M65	4820	0,3
Shoulder lesions	M75	22,843	1,5	Erysipelas	A46	4811	0,3
Asthma	J45	20,524	1,3	Pneumonia, organism unspecified	J18	4768	0,3
Cough	R05	16,979	1,1	Dermatophytosis	B35	4724	0,3
Other dorsopathies, not elsewhere classified	M53	15,269	1,0	Other disorders of urinary system	N39	4624	0,3
Other gastroenteritis and colitis of infectious and unspecified origin	A09	13,994	0,9	Gastro-oesophageal reflux disease	K21	4414	0,3
Other anxiety disorders	F41	13,847	0,9	Fibroblastic disorders	M72	4391	0,3
Otitis externa	H60	13,090	0,9	Dislocation, sprain and strain of joints and ligaments at wrist and hand level	S63	4331	0,3
Acute tonsillitis	J03	12,916	0,8	Fracture at wrist and hand level	S62	4255	0,3
Examination and encounter for administrative purpo	Z02	12,105	0,8	Hordeolum and chalazion	H00	4196	0,3
Other enthesopathies	M77	11,953	0,8	Other hypothyroidism	E03	4088	0,3
Pain in throat and chest	R07	11,238	0,7	Other chronic obstructive pulmonary disease	J44	4082	0,3
Acute pharyngitis, unspecified	J02	9672	0,6	Other inflammation of vagina and vulva	N76	4021	0,3
Dislocation, sprain and strain of joints and ligaments at ankle and foot level	S93	9639	0,6	Fracture of forearm	S52	4009	0,3
Other joint disorders, not elsewhere classified	M25	9528	0,6	Hyperplasia of prostate	N40	4003	0,3
Atopic dermatitis	L20	9392	0,6	Coxarthrosis [arthrosis of hip]	M16	3870	0,3
Soft tissue disorders related to use, overuse and pressure	M70	9350	0,6	Oedema, not elsewhere classified	R60	3714	0,2
Nonsuppurative otitis media	H65	9161	0,6	Gout	M10	3699	0,2
Nonorganic sleep disorders	F51	8919	0,6	Dislocation, sprain and strain of joints and ligaments of knee	S83	3641	0,2
Cellulitis	L03	8775	0,6	Impetigo	L01	3596	0,2
Vasomotor and allergic rhinitis	J30	8648	0,6	Superficial injury of wrist and hand	S60	3541	0,2
Headache	R51	8507	0,6	Diseases of capillaries	I78	3539	0,2
Atrial fibrillation and flutter	I48	8072	0,5	Acne	L70	3504	0,2
Other headache syndromes	G44	8063	0,5	Adverse effects, not elsewhere classified	T78	3371	0,2
Acute laryngitis and tracheitis	J04	8046	0,5	Superficial injury of lower leg	S80	3347	0,2
Disorders of lipoprotein metabolism and other lipidaemias	E78	7726	0,5	Enthesopathies of lower limb, excluding foot	M76	3337	0,2
Other dermatitis	L30	7636	0,5	Open wound of wrist and hand	S61	3249	0,2
Internal derangement of knee	M23	7575	0,5	Recurrent depressive disorder	F33	3236	0,2
Influenza with pneumonia, virus not identified	J11	7513	0,5	Superficial injury of ankle and foot	S90	3182	0,2
General examination and investigation of persons without complaint and reported diagnosis	Z00	7208	0,5	Disorders of vestibular function	H81	3125	0,2
Reaction to severe stress, and adjustment disorders	F43	7193	0,5	Urticaria	L50	3114	0,2
Dyspnoea	R06	7177	0,5	Seropositive rheumatoid arthritis	M05	3086	0,2
Cutaneous abscess, furuncle and carbuncle of face	L02	7161	0,5	Mononeuropathies of upper limb	G56	3052	0,2
Dizziness and giddiness	R42	7130	0,5	Psoriasis	L40	3046	0,2
Pain, not elsewhere classified	R52	6969	0,5	Nail disorders	L60	3020	0,2
Other special examinations and investigations of persons without complaint or reported diagnosis	Z01	6635	0,4	Otalgia and effusion of ear	H92	3020	0,2
Migraine	G43	6360	0,4	Angina pectoris	I20	3014	0,2
Insulin-dependent diabetes mellitus	E10	6304	0,4	Mental and behavioural disorders due to use of alcohol	F10	2992	0,2
Chronic ischaemic heart disease	I25	6270	0,4	Melanocytic naevi	D22	2984	0,2

Table 3. Comparisons of yearly prevalence of the 10 most often recorded diagnoses common to both ED and office-hours practices. Mean±Standard Deviation or Median (25%-75% Interquartile Range) are shown. ** stands for p < 0.01 or *** for p < 0.001 in paired t-test or Wilcoxon signed rank-test (if the median is shown as an estimate)

ICD-Code	Diagnosis	Office-Hour GPs N % of visits with diagnosis % of all visits	ED doctors N % of visits with diagnosis % of all visits
J06	Acute upper respiratory infections of multiple and unspecified sites	10,926 ± 2073 9.86 ± 1.95 5.78 ± 1.28	1568 ± 652*** 6.04 ± 2.59*** 3.29 ± 0.74***
M54	Dorsalgia	6244 ± 1422 5.64(4.84–6.33) 3.31 ± 0.87	1065 ± 221*** 4.24(3.47–4.70)*** 2.36 ± 0.56***
H66	Suppurative and unspecified otitis media	4638 ± 979 4.16 ± 0.77 2.46 ± 0.59	1209 ± 383*** 4.71 ± 1.72 2.57 ± 0.37
J01	Acute sinusitis	3853 ± 477 3.62 ± 1.12 2.03 ± 0.29	723 ± 224*** 1.63 ± 1.18*** 0.81 ± 0.42***
J20	Acute bronchitis	3709 ± 732 3.46 ± 1.04 1.96 ± 0.42	716 ± 376*** 2.79 ± 1.49** 1.47 ± 0.45**
R10	Abdominal and pelvic pain	2666 ± 1268 2.17 ± 0.31 1.43 ± 0.72	1296 ± 566*** 4.66 ± 1.27*** 3.13 ± 1.89***
H10	Conjunctivitis	2493 ± 646 2.21 ± 0.38 1.32 ± 0.38	423 ± 145*** 1.68 ± 0.72** 0.90 ± 0.24**
M79	Other soft tissue disorders, not elsewhere classified	1991 ± 1272 1.55 ± 0.52 1.07 ± 0.71	347 ± 241*** 1.20 ± 0.66*** 0.87 ± 0.72***
A09	Other gastroenteritis and colitis of infectious and unspecified origin	1076 ± 148 1.10 ± 0.33 0.57 ± 0.08	532 ± 121*** 2.02 ± 0.43*** 1.18 ± 0.28***
J03	Acute tonsillitis	950(839–1169) 0.92 ± 0.29 0.52 ± 0.11	351(265–593)*** 1.78 ± 1.10** 0.89 ± 0.31**

Figure 1. Yearly proportions of visits with recorded diagnosis in the ED and in office-hours practices 2002–2014. Mean and 95% Confidence Intervals (brackets) are shown

Data availability statement

The data is available from the corresponding author with a reasonable request.