Chart Reviews In Emergency Medicine Research: Where Are The Methods?

doi:10.1016/S0196-0644(96)70264-0

Annals of Emergency Medicine

Volume 27, Issue 3, March 1996, Pages 305-308

https://doi.org/10.1016/S0196-0644(96)70264-0 Get rights and content

Abstract

Study objective: Medical chart reviews are often used in emergency medicine research. However, the reliability of data abstracted by chart reviews is seldom examined critically. The objective of this investigation was to determine the proportion of emergency medicine research articles that use data from chart reviews and the proportions that report methods of case selection, abstractor training, monitoring and blinding, and interrater agreement. Methods: Research articles published in three emergency medicine journals from January 1989 through December 1993 were identified. The articles that used chart reviews were analyzed. Results: Of 986 original research articles that were identified, 244 (25%; 95% confidence interval [CI], 22% to 28%) relied on chart reviews. Inclusion criteria were described in 98% (95% CI, 96% to 99%), and 73% (95% CI, 67% to 79%) defined the variables being analyzed. Other methods were seldom mentioned: abstractor training, 18% (95% CI, 13% to 23%); standardized abstraction forms, 11% (95% CI, 7% to 15%); periodic abstractor monitoring, 4% (95% CI, 2% to 7%); and abstractor blinding to study hypotheses, 3% (95% CI, 1% to 6%). Interrater reliability was mentioned in 5% (95% CI, 3% to 9%) and tested statistically in .4% (95% CI, 0% to 2%). A 15% random sample of articles was reassessed by a second investigator; interrater agreement was high for all eight criteria. Conclusion: Chart review is a common method of data collection in emergency medicine research. Yet, information about the quality of the data is usually lacking. Chart reviews should be held to higher methodologic standards, or the conclusions of these studies may be in error. [Gilbert EH, Lowenstein SR, Koziol-McLain J, Barta DC, Steiner J: Chart reviews in emergency medicine research: Where are the methods? Ann Emerg Med March 1996;27:305-308.]

Section snippets

INTRODUCTION

Medical record reviews are used frequently to generate original research in emergency medicine. However, although medical records contain important clinical information, they are not produced for research purposes.¹ There are no universally-accepted criteria for a "well-conducted" chart review, but eight methodologic strategies (Figure 1) may enhance the validity, reproducibility, and overall quality of data collected from clinical records.1, 2

. Strategies to improve accuracy and minimize

MATERIALS AND METHODS

Original research articles published between January 1, 1989, and December 31, 1993, were retrieved from the American Journal of Emergency Medicine, Annals of Emergency Medicine, and Journal of Emergency Medicine. Case reports, letters, editorials, subject reviews, metaanalyses, special theme papers, and symposium proceedings were excluded. Those of the original research articles that relied solely or mostly on data from medical records to answer the questions posed by the study were judged to

RESULTS

During the 5-year period ending December 31, 1993, approximately 3,000 articles of all types were published in the three peer-reviewed emergency medicine journals. Of these, 986 were original research articles, among which chart reviews supplied most or all of the important data in 244 (25%; 95% CI, 22% to 28%). The number of chart review articles each year varied from 38 (16%) in 1991 to 61 (25%) in 1990. The majority (65.6%) of chart review articles appeared in Annals of Emergency Medicine.

DISCUSSION

Between 1989 and 1993, one fourth of all scientific investigations published in emergency medicine journals were medical chart reviews. However, as the present investigation indicates, most chart reviews lack sound methods. Frequently, information is collected by poorly trained, unmonitored personnel, who may be aware of the study hypotheses and group or treatment assignments. Most chart reviews do not report the reproducibility of their data. Chart reviews in emergency medicine research may

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^☆: From the Colorado Emergency Medicine Research Center, Division of Emergency Medicine*, and the Division of Internal Medicine^‡, University of Colorado Health Sciences Center, Denver, Colorado.

^☆☆: Address for reprints: Steven R Lowenstein, MD, MPH, Division of Emergency Medicine, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Box B211, Denver, Colorado 80262, 303-270-8711, Fax 303-270-5614

^★: Reprint no. 47/1/69724

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Chart Reviews In Emergency Medicine Research: Where Are The Methods?☆,☆☆,★

Abstract

Section snippets

INTRODUCTION

MATERIALS AND METHODS

RESULTS

DISCUSSION

J Chron Dis

J Chron Dis

J Clin Epidemiol

J Clin Epidemiol

An analysis of the quality of medical record reviews in general medicine journals

Clin Res

The epidemiology of cancer therapy: III. The management of imperfect data

Arch Intern Med

The reliability of clinical methods, data and judgements I and II

N Engl J Med