The accuracy of using ICD‐9‐CM codes to determine genotype and fever status of patients with sickle cell disease

Eisenbrown, Katherine; Nimmer, Mark; Brousseau, David C.

doi:10.1002/pbc.25432

Cited by 14 publications

(17 citation statements)

References 4 publications

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“…First, using ICD-9-CM codes to identify patient genotypes for SCD is inherently imperfect. 50 We chose the most inclusive ICD-9-CM definition for SCD in order to increase patient capture. Population prevalence data suggest that our study sample comprised a mixture of children with hemoglobin SS (65%), hemoglobin SC (25%), hemoglobin Sβ + -thalassemia (8%), and hemoglobin Sβ 0 -thalassemia (2%).…”

Section: Discussionmentioning

confidence: 99%

Preventive Care Delivery to Young Children With Sickle Cell Disease

Bundy

Muschelli

Clemens

et al. 2016

Journal of Pediatric Hematology/Oncology

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Preventive services can reduce the morbidity of sickle cell disease (SCD) in children but are delivered unreliably. We conducted a retrospective cohort study of children ages 2–5 years with SCD, evaluating each child for 14 months and expecting that he/she should receive ≥75% of days covered by antibiotic prophylaxis, ≥1 influenza immunization, and ≥1 transcranial Doppler ultrasound (TCD). We used logistic regression to quantify the relationship between ambulatory generalist and hematologist visits and preventive services delivery. Of 266 children meeting inclusion criteria, 30% consistently filled prophylactic antibiotic prescriptions. Having ≥2 generalist, non-well child care visits or ≥2 hematologist visits was associated with more reliable antibiotic prophylaxis. Forty-one percent of children received ≥1 influenza immunizations. Children with ≥2 hematologist visits were most likely to be immunized (62% versus 35% among children without a hematologist visit). Only 25% of children received ≥1 TCD. Children most likely to receive a TCD (42%) were those with ≥2 hematologist visits. One in twenty children received all three preventive services. Preventive services delivery to young children with SCD was inconsistent but associated with multiple visits to ambulatory providers. Better connecting children with SCD to hematologists and strengthening preventive care delivery by generalists are both essential.

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Section: Discussionmentioning

confidence: 99%

Preventive Care Delivery to Young Children With Sickle Cell Disease

Bundy

Muschelli

Clemens

et al. 2016

Journal of Pediatric Hematology/Oncology

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“…In particular, whether the patient had a fever relied on medical record documentation. However, chart review has been previously shown to identify patients with fever more accurately than using ICD‐9‐CM coding . Although our study focused on a small subset of patients within the larger SCD population, we collected data from two academic medical centers, each with a comprehensive sickle cell center.…”

Section: Discussionmentioning

confidence: 99%

“…All charts were retrieved via an electronic data extraction using these ICD codes. As it has been shown that using ICD‐9‐CM codes to identify fever in patients with SCD is unreliable, we individually reviewed all retrieved charts for documented fever . Any chart with a documented fever ≥38.5°C within the past 24 hours at home, in the ED triage record, or the ED physician note, was included.…”

Section: Methodsmentioning

confidence: 99%

Which Febrile Children With Sickle Cell Disease Need a Chest X‐Ray?

Eisenbrown

Nimmer

Ellison

et al. 2016

Academic Emergency Medicine

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Objective Controversy exists regarding which febrile children with sickle cell disease (SCD) should receive a chest x‐ray (CXR). Our goal is to provide data informing the decision of which febrile children with SCD presenting to the emergency department (ED) require a CXR to evaluate for acute chest syndrome (ACS). Methods Retrospective chart review of children ages 3 months to 21 years with SCD presenting to the ED at one of two academic children's hospitals with fever ≥38.5°C between January 1, 2010, and December 31, 2012. Demographic characteristics, respiratory symptoms, and laboratory results were abstracted. The primary outcome was the presence of ACS. Binary recursive partitioning was performed to determine predictive factors for a diagnosis of ACS. Results A total of 185 (10%) of 1,837 febrile ED visits met ACS criteria. The current National Heart, Lung, and Blood Institute (NHLBI) consensus criteria for obtaining a CXR (shortness of breath, tachypnea, cough, or rales) identified 158 (85%) of ACS cases, while avoiding 825 CXRs. Obtaining a CXR in children with NHLBI criteria or chest pain and in children without those symptoms but with a white blood cell (WBC) count ≥18.75 × 109/L or a history of ACS identified 181 (98%), while avoiding 430 CXRs. Conclusion Children with SCD presenting to the ED with fever and shortness of breath, tachypnea, cough, rales, or chest pain should receive a CXR due to high ACS rates. A higher WBC count or history of ACS in a child without one of those symptoms may suggest the need for a CXR. Prospective validation of these criteria is needed.

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“…Our study, which is a retrospective cohort study using administrative data, has several limitations secondary to this design. First, the use of ICD‐9 codes has relatively low sensitivity (although acceptable specificity) for case finding, as has been shown previously for the primary diagnosis of fever . We may have missed a large number of subjects, but we feel confident those that were classified truly had SCD.…”

Section: Limitationsmentioning

confidence: 88%

Variation in hospital admission of sickle cell patients from the emergency department using the Pediatric Health Information System

Jacob

Mueller

Cochrane

et al. 2019

Pediatric Blood & Cancer

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Background: Universal newborn screening and improved treatment options have led to increased survival in sickle cell disease (SCD). However, patients with SCD still rely heavily on acute care services. Objective:To determine the variation seen in hospitalizations for the top complaints for ED visits for children with SCD nationally. Methods:We performed a retrospective review of the Pediatric Health Information Systems (PHIS) Database between October 2011 and September 2015. Emergency department (ED) encounters were selected by using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes for SCD with and without crisis, fever, and pain. Univariate analyses were performed, as well as index of dispersion (ID) to assess variation by day of the week and region. ANOVA and t-test were used to determine statistical significance. Results:A total of 68 661 ED encounters at 36 hospitals met the criteria for inclusion. Of those encounters, 50.1% were admitted to the hospital. Pain and fever were the most common primary diagnoses among this population. Although variation in hospitalization was seen overall, as well as for a primary diagnosis of pain or fever, this variation was not explained by weekday/weekend designation. Conclusion:The results of our study confirm pain and fever as the most common primary diagnoses for children with SCD who seek acute care, as well as demonstrate that while significant variation in hospitalization exists, it is not associated with day of the week. Further studies to elucidate patient-and hospital-level factors that influence admission variation are necessary. K E Y W O R D Sadolescent, child, emergency department utilization, hematology, sickle cell disease

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The accuracy of using ICD‐9‐CM codes to determine genotype and fever status of patients with sickle cell disease

Cited by 14 publications

References 4 publications

Preventive Care Delivery to Young Children With Sickle Cell Disease

Preventive Care Delivery to Young Children With Sickle Cell Disease

Which Febrile Children With Sickle Cell Disease Need a Chest X‐Ray?

Variation in hospital admission of sickle cell patients from the emergency department using the Pediatric Health Information System

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