Does the International Classification of Disease (ICD-9) Code Accurately Identify Neonates Who Clinically Have Hypoxic-Ischemic Encephalopathy?

Vance, Gregory A.; Niederhauser, Amy; Chauhan, Suneet P.; Magann, Everett F.; Dahlke, Joshua D.; Muraskas, Jonathan; Morrison, John C.

doi:10.1159/000318204

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…The classification is widely used in research, but was created for administrative purpose. Data quality may be of concern, since it does not imply specific diagnostic criteria and errors may occur due to missing or incorrect clinical data or coding [18-20]. …”

Section: Discussionmentioning

confidence: 99%

Prematurity, asphyxia and congenital malformations underrepresented among neonates in a tertiary pediatric hospital in Vietnam

Kruse

Phuong

et al. 2012

BMC Pediatr

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BackgroundEstimated 17,000 neonates (≤ 28 days of age) die in Vietnam annually, corresponding to more than half of the child mortality burden. However, current knowledge about these neonates is limited. Prematurity, asphyxia and congenital malformations are major causes of death in neonates worldwide. To improve survival and long term development, these vulnerable neonates need access to the specialized neonatal care existing, although limited, in lower middle-income countries like Vietnam. The aim of this study was to describe these conditions in a specialized Vietnamese hospital, compared to a Danish hospital.MethodsWe performed a comparative observational study of all neonates admitted to a tertiary pediatric hospital in South Vietnam in 2009–2010. The data were prospectively extracted from the central hospital registry and included basic patient characteristics and diagnoses (International Classification of Diseases, 10th revision). Prematurity, asphyxia and designated congenital malformations (oesophageal atresia, gastroschisis, omphalocoele, diaphragmatic hernia and heart disease) were investigated. In a subgroup, the prematurity diagnosis was validated using a questionnaire. The hospitalization ratio of each diagnosis was compared to those obtained from a Danish tertiary hospital. The Danish data were retrieved from the neonatal department database for a ten-year period.ResultsThe study included 5763 neonates (missing<1%). The catchment population was 726,578 live births. The diagnosis was prematurity in 7%, asphyxia in 2% and one of the designated congenital malformations in 6%. The diagnosis of prematurity was correctly assigned to 85% of the neonates, who were very premature or had very low birth weight according to the questionnaire, completed by 2196 neonates. Compared to the Danish Hospital, the hospitalization ratios of neonates diagnosed with prematurity (p<0.01), asphyxia (p<0.01) and designated congenital malformations (p<0.01- 0.04) were significantly lower.ConclusionOur findings suggest the investigated diagnoses were underrepresented in the Vietnamese study hospital. In contrast, relatively mild diagnoses were frequent. These results indicate the use of specialized care may not be optimal. Pre-hospital selection mechanisms were not investigated and additional studies are needed to optimise utilisation of specialized care and improve neonatal survival.

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Section: Discussionmentioning

confidence: 99%

Prematurity, asphyxia and congenital malformations underrepresented among neonates in a tertiary pediatric hospital in Vietnam

Kruse

Phuong

et al. 2012

BMC Pediatr

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“…Unfortunately, retrospective studies relying on ICD-9 codes have often been shown to be unreliable, given the high error rate in clinical diagnostic coding. [28][29][30][31] Although this study includes a large number of subjects, we lack detailed information about their ADAMTS13 levels and the character of their TMA (if present), thus potentially limiting this prognostic algorithm's utility in TTP patients. Nevertheless, the notion that development of ischemic stroke or myocardial infarction is an adverse prognostic indicator in patients with TTP is plausible.…”

Section: Prognostic Scoring Systems For Ttp Description Of Published mentioning

confidence: 99%

Clinical Scoring Systems in Thrombotic Microangiopathies

Bendapudi

Upadhyay

Sun

et al. 2017

Semin Thromb Hemost

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Thrombotic microangiopathies (TMAs) are a group of rare but potentially lethal hematologic disorders characterized by platelet-rich thrombi in the microvasculature. In evaluating patients with TMA, it is crucial to identify those who have thrombotic thrombocytopenic purpura (TTP), a subtype of TMA that occurs due to a severe deficiency in ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13). Individuals with TTP require urgent therapeutic plasma exchange, which is associated with a significant reduction in mortality; however, at most centers, the results of ADAMTS13 activity testing are usually not available for 3 to 5 days. Given the possible need for urgent intervention and the lack of timely test results to guide therapy, the assessment of patients with TMA represents an ideal situation for the deployment of diagnostic scoring systems to predict the presence of severe ADAMTS13 deficiency. Here, we review the literature surrounding clinical prediction tools in the diagnosis and prognostication of patients with TMA, describe the experience at our center with evaluating TMA patients, and discuss the utility of clinical scoring systems for TMA in the context of patient care.

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“…These variable results have been related to several factors, including the specific codes used for case identification, the source of the data, and whether the data was taken from inpatient or outpatient databases. 4-6 However, the number of studies in the area of cirrhosis is limited and the accuracy of ICD-9 CM codes for the diagnosis of cirrhosis has not been extensively studied 7, 8 . We hypothesized that a carefully selected panel of ICD-9 codes would be able to predict cirrhosis with a high degree of accuracy.…”

Section: Introductionmentioning

confidence: 99%

Use of Administrative Claims Data for Identifying Patients with Cirrhosis

Nehra

Clark

et al. 2013

Journal of Clinical Gastroenterology

180

204

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Background Administrative data are used in clinical research, but the validity of ICD-9 codes to identify cirrhotic patients has not been well established. Goals Determine the diagnostic accuracy of ICD-9 codes for cirrhosis in clinical practice Study We conducted a retrospective cohort study of patients from a safety-net hospital between 2008-2011. Patients were initially identified using ICD-9 codes for cirrhosis or a resultant complication. The gold-standard diagnosis of cirrhosis was histology and/or imaging based on medical record review. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) for each ICD-9 code were calculated. Diagnostic accuracy was assessed by the c-statistic using receiver operator characteristic curve analysis. Results We identified 2,893 patients with an ICD-9 code for cirrhosis, of whom 50.2% had one ICD-9 code, 20.3% had two different codes, and 29.5% had three or more codes. Cirrhosis was confirmed in 44.0% of patients with one ICD-9 code, 82.6% with two codes, and 95.7% of those with at least three codes. Ascites had a significantly lower PPV for cirrhosis than other ICD-9 codes (p<0.001). The optimal combination of ICD-9 codes to identify cirrhotic patients included all codes except that of ascites, with a c-statistic of 0.71 in our derivation cohort. The sensitivity of this combination was confirmed to be 98% in a validation cohort of 285 patients with known cirrhosis. Conclusions Administrative data can identify patients with cirrhosis with high accuracy, although ascites has a significantly lower positive predictive value than other ICD-9 codes.

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Does the International Classification of Disease (ICD-9) Code Accurately Identify Neonates Who Clinically Have Hypoxic-Ischemic Encephalopathy?

Cited by 8 publications

References 24 publications

Prematurity, asphyxia and congenital malformations underrepresented among neonates in a tertiary pediatric hospital in Vietnam

Prematurity, asphyxia and congenital malformations underrepresented among neonates in a tertiary pediatric hospital in Vietnam

Clinical Scoring Systems in Thrombotic Microangiopathies

Use of Administrative Claims Data for Identifying Patients with Cirrhosis

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