The Nationwide Emergency Department Sample (NEDS) is part of a family of databases and software tools developed for the Healthcare Cost and Utilization Project (HCUP). The NEDS is the largest all-payer emergency department (ED) database in the United States, yielding national estimates of hospital-owned ED visits. Unweighted, it contains data from over 30 million ED visits each year. Weighted, it estimates roughly 145 million ED visits. Developed through a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality, HCUP data inform decision making at the national, State, and community levels.

¹ ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification. ICD-10-CM/PCS: International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System.

This page provides an overview of the NEDS. For more details, see NEDS Database Documentation and the Introduction to the NEDS, 2018 (PDF file, 825 KB; HTML).

Contents:

• What's New in the 2018 NEDS?
• About the NEDS
• NEDS Data Elements
• NEDS File Structure
• NEDS Areas of Research and HCUP Publications
• Purchase the NEDS
• NEDS Hardware and Software Requirements

Twelve data elements have been added that identify the mechanism of the injury: cutting/piercing, drowning, falling, fire, firearm, machinery, motor vehicle traffic, natural/environmental, overexertion, poisoning, suffocation, and being struck by or against. Further, 3 data elements have been added that identify the intent of the injury: unintentional, assault, and self-harm. If multiple injuries are reported, more than one mechanism and intent may be identified.

The mechanism of injury is determined by the External Cause of Morbidity Codes and is consistent with the classification system used by the Centers for Disease Control and Prevention (CDC).

In addition, the Diagnosis and Procedure Groups file is available beginning with the 2018 NEDS and includes data elements derived from the Clinical Classifications Software Refined (CCSR) for ICD-10-CM diagnoses.

Sampled from the State Inpatient Databases (SID) and State Emergency Department Databases (SEDD), the HCUP NEDS can be used to create national and regional estimates of ED care. The SID contain information on patients initially seen in the ED and subsequently admitted to the same hospital. The SEDD capture information on ED visits that do not result in an admission (i.e., treat-and-release visits and transfers to another hospital).

NEDS data are available from 2006 through 2018, which allow researchers to analyze trends over time. Key features of the most recent NEDS database year (2018) include:

• A large sample size, which provides sufficient data for analysis across hospital types and the study of relatively uncommon disorders and procedures
• Discharge data for ED visits from 990 hospitals located in 36 States and the District of Columbia, approximating a 20-percent stratified sample of U.S. hospital-owned EDs
• Demographic data such as hospital and patient characteristics, geographic area, and the nature of ED visits (e.g., common reasons for ED visits, including injuries)
• ED charge information for 86 percent of ED visits, regardless of the expected payer for the visit
• Children's hospitals with trauma centers, which are classified with adult and pediatric trauma centers in the current versions of the NEDS.

Information on previous years of the NEDS may be found in the Introduction to the NEDS, 2018 (PDF file, 825 KB; HTML).

Beginning with data year 2016, the NEDS is a calendar year file that includes data with diagnosis and inpatient procedure codes reported using the ICD-10-CM/PCS coding system. The file structure of the NEDS beginning in data year 2016 is similar to its structure in 2014 and prior years.

Beginning quarter 4 of 2015, data elements based on the AHRQ software tools, such as those elements derived from ICD-10-CM/PCS codes, are not available, with one exception. Beginning with data year 2018, the Clinical Classifications Software Refined (CCSR) for ICD-10-CM diagnosis codes is included in the DX_PR_GRPS file in the NEDS. For users interested in applying the AHRQ software tools to the ICD-10-CM/PCS data, the AHRQ software tools are available for download on the Tools & Software section of the HCUP-US website. The Tools Loading tutorial is available on the HCUP Online Tutorial Series page of the HCUP-US website.

For the 2015 NEDS, data elements related to diagnoses and procedures are included in the supplemental ED and inpatient files and each supplemental file is split into two files because of the transition to ICD-10-CM/PCS on October 1, 2015 (the beginning of fiscal year 2016). Nine months of the calendar year 2015 data with ICD-9-CM codes (discharges from January 1, 2015 - September 30, 2015) are in one set of files labeled Q1-Q3. Three months of the calendar year 2015 data with ICD-10-CM/PCS codes (discharges from October 1, 2015 - December 31, 2015) are in a separate set of files labeled Q4. More information about the changes to the HCUP databases for ICD-10-CM/PCS and use of data across the two coding systems may be found on the HCUP-US website under ICD-10-CM/PCS Resources.

The NEDS contains clinical and resource-use information that is included in a typical discharge abstract, with safeguards to protect the privacy of individual patients, physicians, and hospitals (as required by data sources). The NEDS is composed of more than 100 clinical and nonclinical variables for each hospital stay. These include:

• ICD-10-CM/PCS diagnosis, procedure, and external cause of morbidity codes (starting on October 1, 2015)
• ICD-9-CM diagnosis, procedures, and external cause of injury codes (prior to October 1, 2015)
• Current Procedural Terminology, Fourth Edition (CPT®-4) procedure codes on ED visits that do not results in an admission to the same hospital
• Identification of injury-related ED visits and the mechanism and intent of injury (the availability of these data elements varies over time)
• Discharge status
• Patient demographics characteristics (e.g., sex, age, urban-rural designation of residence, national quartile of median household income for patient's ZIP Code)
• Expected payment source (e.g., Medicare, Medicaid, private insurance, self-pay, no charge, and other insurance type)
• Total ED charges (for ED visits) and total hospital charges (for inpatient stays for ED visits that result in admission)
• Hospital characteristics (e.g., region, trauma center indicator, urban-rural location, teaching status)

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As a uniform, multi-State database, the NEDS promotes comparative studies of healthcare services and supports healthcare policy and research on a variety of topics, including:

• Use of and charges for ED services
• Medical treatment effectiveness
• Quality of ED care
• Impact of health policy changes
• Access to care
• Utilization of health services by special populations

The NEDS is used in a variety of publications:

• HCUP Statistical Briefs highlight a variety of health topics.
• Use the HCUP Publications Search Tool to find publications using the NEDS.
• Review featured publications on the HCUP Research Spotlights page.
• Read publications by the winners of the HCUP Outstanding Article of the Year Awards.

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NEDS releases for data years 2006 through 2018 are available for purchase through the HCUP Central Distributor.

All HCUP data users, including data purchasers and collaborators, must complete the online HCUP Data Use Agreement Training Tool, and must read and sign the Data Use Agreement for Nationwide Databases (PDF file, 85 KB; HTML).

Questions regarding purchasing databases can be directed to the HCUP Central Distributor:

E-mail: HCUPDistributor@AHRQ.gov
Telephone: (866) 556-4287 (toll free)
Fax: (866) 792-5313 (toll free)

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The NEDS data set is extremely large. The data are distributed as comma-separated value (CSV) files delivered via secure digital download from the Online HCUP Central Distributor. The files are compressed and encrypted with SecureZIP® from PKWARE.

To load and analyze the NEDS data on a computer, users will need the following:

• The password provided by the HCUP Central Distributor
• A hard drive with 50 to 100 (GB) of space available
• A third-party zip utility such as ZIP Reader, Secure ZIP®, WinZip®, or Stuffit Expander®
• SAS®, SPSS®, Stata® or similar analysis software

The data set includes weights for producing national and regional estimates. NEDS documentation and tools, including programs for loading the CSV file into SAS, SPSS, or Stata, are also available on the NEDS Database Documentation page.

Please note the following based on the software you plan to use:

• In total, the CSV version of the NEDS is 50 gigabytes (GB).
• The NEDS files loaded into SAS are about 12 GB. Most SAS data steps will require twice the storage of the file, so that the input and output files can coexist. The largest use of space typically occurs during a sort, which requires work space approximately three times the size of the file. Thus, the NEDS files would require approximately 40 GB of available workspace to perform a sort.
• The NEDS files loaded into SPSS are about 30 GB.
• Because Stata loads the entire file into memory, it may not be possible to load every data element in the NEDS Core file into Stata. Stata users will need to maximize memory and use the "_skip" option to select a subset of variables. More details are provided in the Stata load programs.

With a file this size and without careful planning, space could easily become a problem in a multi-step process. It is common to produce several versions of a file during data preparation, as well as further multiple versions for analysis. Therefore, the amount of space required could escalate rapidly.

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