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Various factors contribute to the quality of care of an injured patient at the emergency room (ER), and a correct diagnosis can improve and accelerate care. The aim of this study was to evaluate the agreement between diagnoses assigned in the ER and those assigned after hospital admission to patients with unintentional injuries. We also tried to determine the factors that influenced the disagreement, and to evaluate if discordant diagnoses were associated with higher mortality risk.All ER visits for unintentional injuries that were followed by hospital admission at the 60 emergency departments in the Lazio Region in 2000. Concordant diagnoses (ER/discharge) were established based on the Barell matrix cells. Logistic regression was used to assess the role of individual and ER care factors on the probability of concordance. A logistic regression was performed, where death within 30 days was the outcome and concordance was the determinant.We considered 22,892 ER visits for injury that were followed by hospital admission. In 62.2% of cases, the ER and discharge diagnoses were concordant. Higher concordance was found for older patients and less urgent cases. Factors influencing concordance were the hour of the visit, ER specialization degree, initial outcome, and length of hospital stay. Patients who had disconcordant diagnoses had a 30% higher probability of death.A correct diagnosis (i.e. confirmed at hospital discharge) at first contact with the emergency room is associated with lower mortality. Comparing administrative ER and hospital discharge data can be useful in emergency department management studies.