Department of Pediatrics, University of Pennsylvania School of Medicine and Emergency Medicine, The Children's Hospital of Philadelphia, PA, USA.
Acad Emerg Med. 2010 Feb;17(2):204-13. doi: 10.1111/j.1553-2712.2009.00635.x.
A clinically sensible system of grouping diseases is needed for describing pediatric emergency diagnoses for research and reporting. This project aimed to create an International Classification of Diseases (ICD)-based diagnosis grouping system (DGS) for child emergency department (ED) visits that is 1) clinically sensible with regard to how diagnoses are grouped and 2) comprehensive in accounting for nearly all diagnoses (>95%). The second objective was to assess the construct validity of the DGS by examining variation in the frequency of targeted groups of diagnoses within the concepts of season, age, sex, and hospital type.
A panel of general and pediatric emergency physicians used the nominal group technique and Delphi surveys to create the DGS. The primary data source used to develop the DGS was the Pediatric Emergency Care Applied Research Network (PECARN) Core Data Project (PCDP).
A total of 3,041 ICD-9 codes, accounting for 98.9% of all diagnoses in the PCDP, served as the basis for creation of the DGS. The expert panel developed a DGS framework representing a clinical approach to the diagnosis and treatment of pediatric emergency patients. The resulting DGS has 21 major groups and 77 subgroups and accounts for 96.5% to 99% of diagnoses when applied to three external data sets. Variations in the frequency of targeted groups of diagnoses related to seasonality, age, sex, and site of care confirm construct validity.
The DGS offers a clinically sensible method for describing pediatric ED visits by grouping ICD-9 codes in a consensus-derived classification scheme. This system may be used for research, reporting, needs assessment, and resource planning.
为了便于研究和报告，需要有一种临床合理的疾病分组系统来描述儿科急诊诊断。本项目旨在创建一种基于国际疾病分类（ICD）的儿科急诊就诊诊断分组系统（DGS），该系统 1）在诊断分组方式上具有临床合理性，2）在涵盖几乎所有诊断（>95%）方面具有全面性。第二个目标是通过检查季节、年龄、性别和医院类型等概念中目标诊断组的频率变化，评估 DGS 的结构有效性。
一组普通和儿科急诊医生使用名义小组技术和 Delphi 调查来创建 DGS。用于开发 DGS 的主要数据源是儿科急诊护理应用研究网络（PECARN）核心数据项目（PCDP）。
共有 3041 个 ICD-9 代码，占 PCDP 中所有诊断的 98.9%，作为创建 DGS 的基础。专家组制定了一个 DGS 框架，代表了一种针对儿科急诊患者诊断和治疗的临床方法。由此产生的 DGS 有 21 个主要组和 77 个子组，当应用于三个外部数据集时，涵盖了 96.5%至 99%的诊断。与季节性、年龄、性别和护理地点相关的目标诊断组频率的变化证实了结构有效性。
DGS 通过以共识为基础的分类方案对 ICD-9 代码进行分组，为描述儿科急诊就诊提供了一种临床合理的方法。该系统可用于研究、报告、需求评估和资源规划。
