National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Atlanta, GA 30333, USA.
BMC Pediatr. 2013 Jun 7;13:90. doi: 10.1186/1471-2431-13-90.
Rates of laboratory testing and diagnostic practices for congenital CMV in the United States are unknown. We determined rates of CMV testing and diagnostic coding for CMV among insured infants in the United States using a national healthcare claims database.
We analyzed medical claims from 2011 Truven Health MarketScan® Commercial databases for infants who were ≤30 days of age. We used ICD-9-CM codes to identify infants with CMV and CMV-associated conditions. We computed frequencies of infants with CPT codes for CMV testing.
A total of 368,266 infants met the study criteria. We identified 61 (0.02%) infants with a diagnostic code for CMV. Among the 368,266 infants, 229 (0.1%) infants had a code for CMV-specific testing, of which 43% had codes for CMV polymerase chain reaction (PCR) and/or CMV direct florescent antibody (DFA) testing, 44% for CMV serologic testing alone, and 13% for CMV serology and non-specific PCR and/or culture. Over 80% (187/229) with CMV testing had a code for ≥1 CMV-associated conditions. Although infrequently coded for, CMV testing was more common among infants with a code for a condition possibly associated with CMV than infants without these conditions (0.14% (187/ 136,857) vs. 0.02% (42/231,409)).
The low rates of CMV testing among infants with symptoms suggestive of congenital CMV infection and the substantial proportion of infants tested with only serologic assays instead of PCR or viral culture suggests gaps in awareness and knowledge of congenital CMV and its diagnosis among healthcare providers. Although claims databases presumably do not capture all diagnosed CMV cases or CMV-specific testing, healthcare claims are a potential source for surveillance and monitoring practices of CMV-specific testing and diagnostic coding for CMV among infants.
美国对先天性巨细胞病毒（congenital cytomegalovirus，CMV）的实验室检测和诊断实践的比率尚不清楚。我们使用全国医疗保健索赔数据库，确定了美国保险婴儿中 CMV 检测和诊断编码的比率。
我们分析了 2011 年 Truven Health MarketScan®商业数据库中≤30 天龄婴儿的医疗索赔。我们使用国际疾病分类第 9 版临床修正码（ICD-9-CM）对 CMV 婴儿和与 CMV 相关的疾病进行编码。我们计算了 CMV 检测的 CPT 编码的婴儿的频率。
共有 368266 名婴儿符合研究标准。我们发现了 61 名（0.02%）患有 CMV 诊断代码的婴儿。在 368266 名婴儿中，有 229 名（0.1%）有 CMV 特异性检测的代码，其中 43%有 CMV 聚合酶链反应（PCR）和/或 CMV 直接荧光抗体（DFA）检测的代码，44%有 CMV 血清学检测的代码，13%有 CMV 血清学和非特异性 PCR 和/或培养的代码。超过 80%（187/229）进行了 CMV 检测的婴儿有≥1 个与 CMV 相关的疾病代码。尽管编码频率较低，但与没有这些疾病的婴儿相比，有条件可能与 CMV 相关的疾病代码的婴儿进行 CMV 检测的频率更高（0.14%（187/136857）比 0.02%（42/231409））。
在有先天性 CMV 感染症状的婴儿中，CMV 检测率较低，而且只有少数婴儿接受了血清学检测，而不是 PCR 或病毒培养，这表明医疗保健提供者对先天性 CMV 及其诊断的认识和了解存在差距。尽管索赔数据库可能无法捕获所有诊断的 CMV 病例或 CMV 特异性检测，但医疗保健索赔是监测和监测婴儿 CMV 特异性检测和诊断编码实践的潜在来源。
