Journal of Clinical Epidemiology 59 (2006) 791–797

ORIGINAL ARTICLES

Health care utilization: measurement using primary

care records and patient recall both showed bias
Kelvin Jordan*, Clare Jinks, Peter Croft
Primary Care Sciences Research Centre, Keele University, Keele ST5 5BG, United Kingdom
Accepted 5 December 2005

Abstract
Objective: To assess reasons for discrepancies between primary care consultation measured from patient self-report and that based on
medical records.
Methods: Retrospective comparison of recalled consultation in previous 12 months among 2,414 subjects aged 501 who reported
knee pain in a population survey vs. primary care medical records. Record review included (1) all knee morbidity codes and (2) knee prob-
lems mentioned in consultation text. It was then extended to: (3) more than 12 months before survey, and (4) consultations for leg or wide-
spread problems (e.g., generalized osteoarthritis).
Results: In those who reported knee pain, recalled consultation prevalence for knee problems ‘‘in past year’’ was 33% compared with
15% based on medical records. Forty percent of those with a recalled consultation had a recorded knee problem in the same time period
(kappa 5 0.43). Expanding record search to include leg and widespread problems, and knee problems up to 40 months prior to survey,
increased ‘‘verified’’ self-reported consulters to 80%.
Conclusions: Disparity in estimates of consultation prevalence arose from inaccuracy of: (1) recall in survey responders and (2) record-
ing by general practitioners of specific problems and repeat consultations. Perceived importance of problem in a multiproblem contact and
whether it leads to an outcome (e.g., prescription) may influence recording. Implications exist for service provision projections and re-
search. Ó 2006 Elsevier Inc. All rights reserved.
Keywords: Health care surveys; Knee; Medical records; Primary health care; Utilization

1. Introduction or computer records of the patient’s general practice

[11–16]. In general, these latter studies have found disagree-
Epidemiologic studies (including general population
ment. However, none have established whether the discrep-
surveys) often ask subjects to self-report health problems
ancies are predominantly a problem of patient recall or of
and recall related consultations to primary care. In the
underrecording in the practice. Identifying the reasons for
UK, this self-reported data can be used for the purposes disagreement and estimating the bias in using either source
of population-based needs assessment by Primary Care
to obtain the prevalence of consultation will assist re-
Trusts who plan and commission health services for their
searchers and policy makers in planning and interpreting
local population. Unmet needs in the community may be
research and in the provision of health care services.
identified if there are people with health problems who
We have therefore assessed (1) the agreement between
are not seeking health care, and self-reported data can also
recalled and recorded general practice consultation using
be used for costing health care related to specific condi-
knee pain as an example, and (2) reasons for discrepancies
tions. An alternative source of health care utilization data
between self-report and practice records by investigating
is the primary care medical record. whether such discrepancies disappear if the medical record
Many studies have found variable levels of agreement on
search is expanded in terms of the time period and the di-
diagnoses between self-reported questionnaire data and
agnoses covered.
medical records [1–10]. Fewer studies have investigated
the agreement between recalled consultation for specific
problems and the record of that consultation in the paper 2. Methods
Six thousand seven hundred ninety-two (adjusted re-
* Corresponding author: Tel.: (144) 1782 583924; fax: (144) 1782 583911. sponse 77%) subjects returned a completed questionnaire
E-mail address: k.p.jordan@cphc.keele.ac.uk (K. Jordan). from a general population survey of all adults (n 5 8,995)
0895-4356/06/$ – see front matter Ó 2006 Elsevier Inc. All rights reserved.
doi: 10.1016/j.jclinepi.2005.12.008
792 K. Jordan et al. / Journal of Clinical Epidemiology 59 (2006) 791–797
aged 50 and over registered at three general practices in
North Staffordshire, UK [17]. Three thousand twenty-three
responders reported knee pain and, of these, 2,414 (80%)
consented to medical record review and responded to the
question on consulting a general practitioner (GP) for their
knee pain. These 2,414 respondents form the study popula-
tion for the analysis in this article. The GP consultation
question asked ‘‘Have you consulted your GP (family doc-
tor) in the last 12 months because of your knee pain?’’
Eight hundred seven (33%) said they had consulted their
GP, and these were classified as having a recalled knee pain
consultation. The North Staffordshire Local Research
Ethics Committee approved the study.
The study practices are part of the North Staffordshire
and Cheshire General Practice Research Network and un-
dertake training, assessment, and feedback in the quality
of their computerized morbidity coding [18]. Morbidities
are entered onto the computer in these practices using the
Read Code classification, a hierarchy of morbidity, symp-
tom, and process codes commonly used in the UK [19]. Es-
timates show that 92% of doctor contacts at the three
practices were given a Read Code in the 18 months prior
to the survey. However, as well as the Read Code, text
can be entered to give more detail on the consultation,
and is often used to detail additional problems discussed
during multiproblem contacts.
To compare subject recall of a knee pain consultation
with information recorded in the electronic medical re-
cords, a stepped approach was undertaken to searching
these records.
3. Part 1dAll subjects
For steps 1–3, only knee disorder contacts recorded in
the general practice medical records as being to the GP sur-
gery, a home visit, or by telephone were considered as ver-
ifying the recalled consultation. This meant entries of
hospital letters, for example, were excluded. After each
step, the percentage of those with a recalled consultation
who had a recorded consultation identified in the search
for that step was determined. This was repeated for those
who said they had not consulted. To show the level of agree-
ment between recalled consultation and medical records,
kappa (k) statistics were calculated with 95% confidence in-
tervals (CI). Interpretation of the kappa values were based
on that given by Shrout [20], with 0.61–0.8 regarded as
moderate agreement and 0.81 and higher as substantial.
3.1. Step 1
The medical records of all 2,414 patients were searched
to identify all consultations which had a knee-related Read
Code allocated for the recall period (12 months prior to the
date of response to the survey). The Read Codes are pub-
lished in the Appendix, which appears on the journal’s
Website (www.elsevier.com).
3.2. Step 2
Further searches, using the keywords ‘‘knee’’ and ‘‘pa-
tella’’ were made to identify musculoskeletal-related knee
disorders mentioned in the texts of consultations of subjects
without such a code. Searches were made independently by
two observers (KJ, CJ). Where disagreement existed between
the two observers over whether the text contained a musculo-
skeletal-related knee disorder, a third observer acted as arbiter.
3.3. Step 3
The processes for Steps 1 and 2 were extended for an ex-
tra 6 months to encompass 18 months prior to the response
to the survey. The extension to 18 months allowed explora-
tion of the presence of telescoping in respondent’s recall
and initial exploration of the effects of underrecording of
repeated consultations for chronic knee pain. Telescoping
occurs when a consultation with a GP that occurred outside
of the requested recall period is reported (e.g., a respondent
visited their doctor 18 months ago but reports this as a con-
sultation within the last 12 months). Based on findings from
our pilot study, we assumed that telescoping was unlikely to
stretch beyond 6 months after the 1-year recall period [21].
Following step 3, analysis was performed to assess, for
those patients who recalled a consultation, which factors
were associated with having a recorded knee problem in their
medical records. This was performed using multiple logistic
regression and odds ratios (OR) with 95% CI are reported.
The factors explored were age, gender, general practice, ed-
ucation status, cohabiting status, anxiety and depression
(based on the Hospital Anxiety and Depression scale) [22],
widespread pain (Manchester definition using a body mani-
kin) [23], history of knee injury which resulted in seeing
a doctor, chronicity of pain (pain of 3 months or more in last
12), laterality of pain, severity of pain and disability (defined
as having recorded severe or extreme pain on any of the pain
or physical function items on the Western Ontario and
McMaster Universities Osteoarthritis Index) [24,25], and
overall frequency of consultation over 12 months.
4. Part 2dSubjects without a recorded
consultation in Part 1
All subjects who recalled a knee pain consultation but
had no record of a knee disorder consultation in steps
1–3 were selected. An equal number of those said they
had not consulted (equally divided across practices) and
had no record of a knee disorder in steps 1–3 were ran-
domly selected. All searches for steps 4–7 were performed
by KJ and CJ, who were blinded as to whether the subject
had recalled a consultation or not.
4.1. Step 4
The Read Codes and consultation texts of all selected
subjects were searched for mention of a leg problem for
the 18 months prior to the survey.
 K. Jordan et al. / Journal of Clinical Epidemiology 59 (2006) 791–797
4.2. Step 5
The Read Codes and consultation texts were searched
for mention of a widespread or generalized disorder (e.g.,
generalized osteoarthritis, arthralgia of multiple joints) for
the 18 months prior to the survey.
4.3. Step 6
The Read Codes and consultation texts were searched
for mention of a knee disorder for the 18 months prior to
the survey in a contact recorded as nonsurgery (e.g., re-
corded as hospital or administration). This allowed explora-
tion of subjects recalling secondary care use rather than
primary care. It also accounted for possible incorrect loca-
tion recording by the GP.
4.4. Step 7
The Read Codes and consultation texts were searched
for mention of a knee disorder for the time period 18–40
months prior to the survey in a contact recorded as surgery,
home visit, or telephone. This further explored the possibil-
ity of underrecording of repeated consultations for chronic
knee pain by the practitioner.
5. Results
5.1. Part 1: Steps 1–3
Two hundred fourteen (27%) of the 807 responders with
a recalled consultation for knee pain had a knee-related
Read Code in their medical records for the 12 months be-
fore the survey (Table 1). Agreement on consultation be-
tween the medical records for this 12-month period and
self-report was slight based on Shrout’s [20] definitions
(k 5 0.30; 95% CI 0.27, 0.34). By extending the search
to knee problems mentioned in the text, the number of re-
sponders who reported a consultation who also had a re-
corded consultation increased to 324 (40%). Only a small
number of the 1,607 patients (n 5 47, 3%) who reported
they had not consulted their GP had a recorded instance (ei-
ther code or text) of consultation in the 12 months before
the survey. However, agreement between medical records
and self-report was still only fair (k 5 0.43; 95% CI
0.39, 0.47).
Table 1
Recorded consultation by recalled consultation for knee pain (reporters of knee pain only)
Recorded consultation
12 months before survey response
Step 1
Self-report status Total Knee code
Report consultation 807 214 (26.5%)
Report no consultation 1607 24 (1.5%)
793
The primary care medical records suggest an annual
consultation prevalence for knee pain, within those who re-
port knee pain, of 15% (n 5 371); this was less than half
that suggested by self-report (n 5 807, 33%). Based on
Read Code evidence only (i.e., not including text), medical
record prevalence is 10% (n 5 238).
Increasing the time period to 18 months before the sur-
vey increased the number of responders with a recalled
consultation who had a confirmed record of knee consulta-
tion to 383 (47%). However, agreement between recalled
and recorded consultation remained only fair (k 5 0.46;
95% CI 0.42, 0.50).
Table 2 shows that, among those who recalled that they
had had a consultation for knee pain, females (OR 1.7, 95%
CI 1.2, 2.4), those in practice B (OR 1.4, 95% CI 1.0, 2.1),
and those with a history of knee injury (OR 1.5, 95% CI
1.1, 2.1) were more likely to have a record of a knee con-
sultation within 18 months. Greater depression (OR 0.7,
95% CI 0.5, 1.0), reporting widespread pain (OR 0.6,
95% CI 0.4, 0.9) and reporting bilateral knee pain (OR
0.7, 95% CI 0.5, 1.0) were all associated with not having
a recorded consultation. Although having less severe pain
or disability was also related to having a recorded consulta-
tion in the unadjusted analysis, this effect was less marked
when adjusted for the other factors. Chronicity of pain was
not associated with recording or not of a knee related
consultation.
5.2. Part 2: Steps 4–7
Four hundred twenty-four subjects who recalled a knee
pain consultation remained unverified after steps 1–3. Four
hundred twenty subjects (140 per practice) were randomly
selected from those without a recalled knee pain
consultation.
Table 3 show the results of steps 4–7. At each step, just
under three times the number of those with a recalled knee
consultation had an identified consultation compared to
those who said they did not have a knee consultation. 94
(22%) of the 424 self-reported consulters had a recorded
leg problem in the 18 months prior to the survey. Another
57 (13%) had recorded generalized problems. Ten patients
(all who had recalled a consultation for knee pain) had
a nonsurgery recorded knee problem within the 18 months.
Expanding the search for knee problems either coded or in
18 months before survey response
Step 2 Step 3
Knee code or text Knee code Knee code or text
324 (40.1%) 253 (31.4%) 383 (47.5%)
47 (2.9%) 50 (3.1%) 100 (6.2%)
794 K. Jordan et al. / Journal of Clinical Epidemiology 59 (2006) 791–797

Table 2
Associations with recorded GP knee disorder (coded or text) consultation within 18 months (steps 1–3) for those recalling consultation (n 5 807)
Total Recorded consultation n (%) ORa 95% CI ORb 95% CI
Recalled consultation 807 383 (47%)
Male 338 143 (42%) 1.00 1.00
Female 469 240 (51%) 1.43 1.08, 1.89 1.69 1.21, 2.35
Aged 50–64 376 188 (50%) 1.00 1.00
Aged 65–74 248 117 (48%) 0.89 0.65, 1.23 0.91 0.64, 1.32
Aged 751 183 78 (43%) 0.74 0.52, 1.06 0.78 0.51, 1.21
Practice A 208 97 (47%) 1.00 1.00
Practice B 368 186 (51%) 1.17 0.83, 1.64 1.42 0.96, 2.10
Practice C 231 100 (43%) 0.87 0.60, 1.27 1.02 0.67, 1.55
No further education 698 329 (47%) 1.00 1.00
Further education 80 42 (53%) 1.24 0.78, 1.97 1.17 0.70, 1.97
Not cohabiting 264 116 (44%) 1.00 1.00
Cohabiting 537 263 (49%) 1.23 0.91, 1.65 1.15 0.81, 1.64
Not most anxious 469 237 (51%) 1.00 1.00
Most anxiousc 314 135 (43%) 0.74 0.55, 0.98 0.94 0.65, 1.34
Not most depressed 444 237 (53%) 1.00 1.00
Most depressedd 341 137 (40%) 0.59 0.44, 0.78 0.67 0.47, 0.97
Not widespread pain 621 318 (51%) 1.00 1.00
Widespread pain 186 65 (35%) 0.51 0.36, 0.72 0.58 0.39, 0.86
No previous injury 309 133 (43%) 1.00 1.00
Previous injury 468 239 (51%) 1.38 1.03, 1.84 1.48 1.07, 2.05
Not chronic pain 186 94 (51%) 1.00 1.00
Chronic paine 616 287 (47%) 0.85 0.62, 1.19 1.06 0.71, 1.57
Unilateral pain 345 188 (54%) 1.00 1.00
Bilateral pain 456 194 (43%) 0.62 0.47, 0.82 0.72 0.52, 1.00
Not severe pain/disability 229 126 (55%) 1.00 1.00
Severe pain/disability 568 252 (44%) 0.65 0.48, 0.89 0.86 0.59, 1.26
Not frequent consulter 555 276 (50%) 1.00 1.00
Frequent consulterf 252 107 (42%) 0.75 0.55, 1.01 0.82 0.59, 1.15
Abbreviations: CI, confidence interval; HADS, Hospital Anxiety and Depression scale; OR, odds ratio.
a
Unadjusted.
b
Adjusted for other presented variables.
c
Above the top tertile on HADS anxiety scale.
d
Above the top tertile on HADS depression scale.
e
Pain for more than 3 months in last 12.
f
Above the top quintile in total number of consultations in last 12 months.

the text beyond the 18-month study period detected another
98 subjects who had reported a consultation.
In total, 61% of the 424 subjects who stated they had
consulted and were included in the Part 2 analysis had an
identified consultation in steps 4–7. This increased the per-
centage of all self-reported consulters with a potential re-
corded knee disorder consultation to 80%. This was
compared to 21% of the 420 without a recalled consultation
included in the Part 2 analysis and an estimated 26% of all
1,607 who did not recall a consultation with evidence of
a possible knee-related consultation.
There were 483 people in the study population who
stated that they had consulted about knee pain in the 12
months prior to the survey but who had no record of this
after steps 1 and 2 of the record review. Tables 1 and 3
show that in steps 3 to 7, 318 (66%) of the 483 were found
to have consulted about things such as ‘‘leg pain’’ or con-
sulted with a knee problem outside the 12-month period.
A broad assumption can be made that the rate of consulta-
tion in steps 3–7 in those who did not recall a consultation
for knee pain (24%) provides an estimate of the proportion
of these other consultations that did not refer to a knee
problem inside the 12-month period. Applying this estimate
to the 483 subjects leaves 42% (66–24) of the 483 (n 5
203) with a recorded consultation that probably included
knee pain and was in the 12-month recall period. Adding
these to the 324 people verified in steps 1 and 2 gives
a crude estimate of the true rate of annual consultation
for knee pain among subjects reporting knee pain of 22%
(527 of 2,414). As the recalled consultation rate was
33%, this suggests that around two-thirds of those who re-
called a consultation (22 of 33) are likely to be referring to
a definite knee disorder consultation within the 12-month
recall period.
6. Discussion
Measures of health service utilization may be derived
from self-reported population data or from general practice
medical records. We have compared the prevalence of self-
reported consultation to that recorded in general practice
 K. Jordan et al. / Journal of Clinical Epidemiology 59 (2006) 791–797
Table 3
Subjects with an identified recorded consultation in medical records
Recalled consultation
a b
Step n Cumulative %
1–3: knee consultation in 18-month study period 383 d 47
4: leg/lower limb consultation in 18-month study period 94 22
at surgery
5: generalized/widespread pain consultation in 57 36
18-month study period at surgery
6: knee consultation in 18-month study period, nonsurgery 10 38
7: knee consultation before 18-month study period at surgery 98 61
% with a recorded consultation 61
% without a recorded consultation 39
Total % 100 (n 5 424)
a
Number of subjects first identified in medical records at that step.
b
Excluding those ‘‘identified’’ in steps 1–3.
c
Including those ‘‘identified’’ in steps 1–3.
d
Estimated based on all those who did not recall a consultation.
and determined that substantial discrepancy exists. Only
40% of self-reported consulters over 1 year could be veri-
fied by examining medical records for the identical time pe-
riod for knee problems. In contrast, the rate of incorrect
reporting of nonconsultation in the present study was very
low; 3% of those who said they had not consulted had
a knee code or text mentioned in their records. This latter
finding is similar to other studies [21,26].
Error in the reporting of consultations from subject self-
report may arise from recall bias. Inaccurate recall of infor-
mation may occur through problems of memory. In the cur-
rent study of knee pain, evidence exists for ‘‘telescoping,’’
with 7% of those recalling a consultation having a knee
code or text in the 6 months prior to the 12-month recall
period. Telescoping may not necessarily be a mistake on
the part of the subject; it may represent the patient recalling
something they feel is important and that they want to con-
vey regardless of whether it took place within the specified
time frame. The result is a ‘‘bias’’ towards overestimating
the actual consultation frequency.
The expansion of the search beyond 18 months suggest
that another possible explanation for discrepancies is
underrecording of chronic knee pain, and this may also ac-
count for some of this 7%. If patients have previously con-
sulted with the condition, subsequent consultations may not
be recorded (particularly if treatment is not provided or
changed). These findings are consistent with a pilot study
of 18 patients reporting knee pain that showed reasonable
agreement between self–reported consultation and paper re-
cords when the search was extended from 12 to 36 months
[21]. Self-reported duration of the pain in our study was not
associated with higher recorded consultation in those re-
calling consultation; however, chronicity in the question-
naire was defined as 3 or more months in the past year,
probably too short to affect GP recording.
Previous studies have concentrated on agreement on
number of physician visits, rather than agreement on
whether any consultation took place. Underreporting of
795
Recalled no consultation
c
Cumulative % na Cumulative %b Cumulative %c
d 6
59 32 8 13d
66 21 13 18d
67 0 13 18d
80 34 21 26d
80 21 26d
20 79 74d
100 (n 5 807) 100 (n 5 420) 100 (n 5 1607)
number of physician visits in general by elderly people is
a consistent finding [11,14,15,27]. However, this bias to-
wards underreporting has been shown to increase in line
with the number of health care visits [13,27]. By contrast,
poorer perceived health status and greater history of disease
have been linked to overreporting of number of consulta-
tions [11,15,27]. Coexistence of other health problems
may also lead to underrecording of specific problems by
the GP when presented with multiple problems at one con-
tact, particularly if this leads to time pressures within the
consultation. In our study, those recalling a consultation
who had widespread pain and greater depression, according
to the self-reported questionnaire data, had lower odds of
having a recorded consultation than those who were less de-
pressed or with no widespread pain. In the overall study
sample, 57% of respondents with knee pain had pain in
two or more other joint sites. This suggests that some pa-
tients with knee pain are actually consulting about knee
pain as part of a wider pain spectrum. This is further sub-
stantiated by the finding that 36% of those who reported
a consultation but without a recorded knee consultation
had a leg or generalized/widespread pain consultation,
compared to just 13% of those who reported no consulta-
tion. The association of self-reported bilateral knee pain
with no recorded evidence may relate to bilateral pain also
being a marker for pain in several joints.
Overall, 80% of those who said they had consulted for
knee pain had a possible true knee consultation. After ad-
justment for the rates of consultation in those who did
not recall a consultation, about two-thirds of recalled con-
sultation could be verified. However, there is likely to be
a proportion who did mention knee pain in an unrelated
consultation (i.e., not for a leg or widespread pain problem)
but where knee pain never got recorded. Or they may have
mentioned referred pain from a hip or low back problem
that was only recorded as a hip or low back problem. These
are likely to be where knee pain played a less significant
part in the consultation. We cannot estimate the size of this
796 K. Jordan et al. / Journal of Clinical Epidemiology 59 (2006) 791–797
group. The GPs may only code what they see as the major
problem that is presented in the consultation (and may in-
terpret the content of the consultation differently to pa-
tients) and may only code consultations that were
consequential in terms of action. The GP medical record
may be a better estimate of prevalence of knee pain consul-
tations where the knee pain was a major part of the consul-
tation. Self-report may be a better estimate of any
consultation in which knee pain was mentioned. Conse-
quences of the health care consultation (e.g., prescription
or referral) have been found to influence level of agreement
between self-report and medical records in a study about
cancer screening procedures [28].
Similar reasons for discrepancies are likely to exist be-
tween self-reported and practice-recorded consultation for
other conditions apart from knee pain. This is particularly
true for other joint pains, but recall error by the subject
and lack of specificity, underrecording consultations for
chronic problems, and underrecording of multiple problems
at one contact by GPs will affect agreement between the
two sources for many conditions. However, knee pain does
not have a clearly defined classification system or diagnos-
tic criteria and symptoms often fluctuate, meaning the im-
pact of the condition can vary over time. This contrasts
with conditions like diabetes and hypertension, where diag-
nosis is more clear cut; medications and treatments are con-
sistently taken and where people are more likely to be in
contact with services. These issues may all affect patient re-
call of diagnosis and contact with their general practitioner.
Some studies have reported better agreement between self-
reported diagnosis and medical record diagnosis for cardio-
vascular diseases than for musculoskeletal conditions
[3,9,29].
The self-reported data was derived from a population
survey of patients registered at three practices in a GP re-
search network. The general practices are in a range of so-
cioeconomic areas (a rural affluent town, a semirural mixed
deprived and affluent area, an urban deprived area) [30].
The initial survey achieved a 77% response rate in males
(75% response), with the younger ages (50–64, 74% re-
sponse) being slightly less likely to respond. Twenty per-
cent of survey responders with knee pain were excluded,
as they did not give consent for review of their medical re-
cords or did not complete the question on GP consultation;
females (22%) and the oldest age group (751, 24%) were
slightly more likely to be excluded at this stage. The high
inclusion rate (80%) and the small differences by gender
and age are unlikely to cause a large bias in the results,
and although it could be hypothesized that the oldest ages
may have poorer recall, age was not independently linked
with a recorded consultation.
For the purposes of analysis we have assumed that codes
and text found in the medical records are correct in that
they accurately represent what the GPs wished to enter.
The low percentage (3%) of those without a recalled con-
sultation with a knee-related code or text within the
12-month recall period suggests this is reasonable. How-
ever, coding of consultations in the practices used may be
more reliable than coding in other practices due to the au-
dit, feedback, and training in this particular network [18].
This study reports moderate agreement between recalled
consultation for knee pain in older adults and recorded con-
sultation in general practice records. Researchers and ser-
vice providers need to be aware of the biases that exist in
both sources of data when estimating health care use. Pop-
ulation-based needs assessment using self-report data will
have to take into account overestimation of contact with
services. Both types of data are required to enable an accu-
rate assessment of health care use in older adults in the gen-
eral population.
Acknowledgments
We are very grateful to all the survey responders, the
North Staffordshire and GP Research Network, and admin-
istration staff at Primary Care Sciences Research Centre,
Keele University. This study was funded by an NHS Exec-
utive (West Midlands) New Blood Research Training Fel-
lowship and the Haywood Rheumatism Research and
Development Foundation.
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Appendix Read Code Read term

List of Read Codes (Version 5) for defining a knee N084a Flexion contracturedknee
disorder consultation N0856 Knee joint ankylosis
N085P Ankylosis of the knee joint
Read Code Read term N0906 Knee joint effusion
14G3. H/O: knee problem N090M Effusion of knee
16J4. Swollen knee N0916 Haemarthrosis of the knee
2H29. O/Edknee joint abnormal N091M Haemarthrosis of knee
4B28. Knee joint synovial fluid N092M Villonodular synovitis of knee
52A. Knee X-ray N0946 Knee joint pain
52A7. Plain X-ray knee N094M Arthralgia of knee
52A8. Patella X-ray N094W Anterior knee pain
52AB. Stress X-ray knee N0956 Knee stiff
54O. Arthrography of knee N095M Stiff knee NEC
7H372 Excision of ganglion of knee N0966 Knee gives way
7H379 Aspiration of gangliondknee N096M Other symptomsdknee
7H382 Reexcision of ganglion of knee N098B Synov osteochondromatdknee
7H422 Plastic repair infrapat tendon N099C Clicking knee
7K12D Arthroscop debridement patella N09A. Patellofemoral disorder
7K1L6 Closed reduction # knee N09AX Disorder of patella, unspec
7K3. Knee joint operations N2159 Iliotibial band syndrome
7K6aD Manipulation of knee joint N216. Enthesopathy of knee
7K6GA Closed reduction disloc knee N220z Synovitis of knee
7K6GB Closed reduct disloc patella N2222 Beat knee
7K6T4 Lateral release of knee N2224 Miners’ knee
7K6Z7 Inject steroid into knee joint N2225 Housemaids’ knee
7K6Z8 Aspiration of fluid knee joint N2246 Ganglion of knee
7K6ZB Inj hydrocort acetat knee jt N224A Baker’s cyst
7K6ZE Inject Lederspan knee joint N2251 Ruptur poplit space synov cyst
7L063 Batch disarticulation of knee N2266 Patellar tendon nontraum.rupt.
7L0H0 Open reduct congen disloc knee N22y4 Synovial plica of knee
7L1G6 Splinting of knee N22yJ Abscess of bursadknee
7NC58 [SO]Ligament of knee N2431 Hypertrophy of knee fat pad
7NC59 [SO]Medial collat lgmnt knee N300R Acute osteomyelitisdpatella
7NC5A [SO]Lateral collat lgmnt knee N302R Infection of patella
7NC5B [SO]Anterior cruciate ligament N310F Paget’s diseasedpatella
7NC5C [SO]Posterior cruciate ligamnt N3241 Juv.osteoch.primary.patell.ctr
8D453 Flexible knee support N3243 Juv.osteoch.secondary.pat.ctre
8D454 Collateral ligament brace N3270 Osteochondritis dissecdpatella
8D455 Anterior cruciate ligam brace N3272 Other osteochondr dissecdknee
8E865 Cont passive mobilisdknee N32z2 Osteochondritis of knee
A152. Tuberculosis of knee N3373 Algodystrophy of knee
B7522 Ben neop soft tiss. knee NEC N364. Acquired genu valgum/varum
N0106 Knee pyogenic arthritis N365. Genu recurvatumdacquired
N01wB Reactive arthropathy of knee N366. Acquired knee deformity NOS
N01zK Infec arthritis NOSdknee N368. Other knee deformity
N0216 Chondroc.-pyrophos.dknee N36yD Deformity of patella
N02zK Crystal arthropathy NOSdknee Nyu35 [X]Other derangements/patella
N03xB Arthr assoc oth disdknee Nyu36 [X]Other disorders of patella
N040D Rheumatoid arthritis of knee Nyu37 [X]Other meniscus derangements
N0536 Patellofemoral osteoarthritis Nyu38 [X]O spontn disrptn/lig(s)knee
N05z6 Knee osteoarthritis NOS Nyu39 [X]Oth intrnl derangemnts/knee
N05zL Osteoarthritis NOS, of knee Nyu3E [X]Disorder of patella, unspec
N061M Traumatic arthropathydknee NyuA1 [X]Other bursitis of knee
N064M Transient arthropathydknee PE41. Congenital dislocation of knee
N06z6 Knee arthritis NOS PE8y8 Congen flex contracturedknee
N07. Internal derangement of knee PF64. Congenital knee joint deform.
N0826 Knee pathological dislocation PF641 Cong.genu valgum (knock-knee)
N082Q Path dislocdknee joint PF644 Cong.dislocation of patella
N082R Path dislocdpatellofem joint PF64z Congen.knee joint def.NOS
N0836 Kneedrecurrent dislocation PGy3. Nail-patella syndrome
N083n Recurrent dislocdknee S32. #Knee-cap
N083p Recurrent dislocdpatella S46. Current knee cartilage tear
N083q Recurrent subluxdpatella S4F. #-dslc/subluxation knee
N083r Habitual dislocdpatella S534. Sprain, patellar tendon
N0846 Knee joint contracture S54. Knee sprain
 K. Jordan et al. / Journal of Clinical Epidemiology 59 (2006) 791–797 797.e2

Read Code Read term

S540. Sprn/prt tr,knee,lat coll lgmt
S541. Sprain med.collateral lig.knee
S542. Sprain cruciate ligament knee
S54w. Other specified knee sprain
S54y. Knee sprain NOS
S5C. Complete tear, knee ligament
S5K. Open division ligament knee
S5U2. Rupture patellar tendon
SA1. Open wound of knee leg and ankle
SA100 Open wound of knee
SE411 Contusion knee
SK170 Other knee injury
ZV49z [V] Problem knee