Rutz H, Hogan B, Hook S, Hinckley A, Feldman K
Emerging Infections Program, Maryland Department of Health, Baltimore, MD, USA.
Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA.
Zoonoses Public Health. 2018 Mar;65(2):254-259. doi: 10.1111/zph.12446. Epub 2018 Feb 6.
In Maryland, Lyme disease (LD) is a reportable disease and all laboratories and healthcare providers are required to report to the local health department. Given the volume of LD reports and effort required for investigation, surveillance for LD is burdensome and subject to underreporting. We explored the utility of International Classification of Diseases, 9th Revision, Clinical Modification (administrative) codes for use with LD surveillance. We aimed to collect the administrative codes for a 10% sample of 2009 LD reports (n = 474) from 292 facilities stratified by case classification (confirmed, probable, suspected and not a case). Sixty-three per cent (n = 184) of facilities responded to the survey, and 341 different administrative codes were obtained for 91% (n = 430) of sampled reports. The administrative code for Lyme disease (088.81) was the most commonly reported code (133/430 patients) among sampled reports; while it was used for 62 of 151 (41%) confirmed cases, it was also used for 48 of 192 (25%) not a case reports (sensitivity 41% and specificity 73%). A combination of nine codes was developed with sensitivity of 74% and specificity of 37% when compared to not a case reports. We conclude that the administrative code for LD alone has low ability to identify LD cases in Maryland. Grouping certain codes improved sensitivity, but our results indicate that administrative codes alone are not a viable surveillance alternative for a disease with complex manifestations such as LD.
在马里兰州，莱姆病（LD）是一种应报告疾病，所有实验室和医疗服务提供者都必须向当地卫生部门报告。鉴于莱姆病报告的数量以及调查所需的工作量，莱姆病监测工作繁重且存在报告不足的情况。我们探讨了国际疾病分类第九版临床修订本（行政管理）编码在莱姆病监测中的实用性。我们旨在收集2009年莱姆病报告中10%样本（n = 474）的行政管理编码，这些样本来自292个按病例分类（确诊、疑似、可能和非病例）分层的机构。63%（n = 184）的机构回复了调查，在91%（n = 430）的抽样报告中获得了341个不同的行政管理编码。莱姆病的行政管理编码（088.81）是抽样报告中最常报告的编码（133/430例患者）；它在151例确诊病例中的62例（41%）中被使用，同时也在192例非病例报告中的48例（25%）中被使用（敏感性为41%，特异性为73%）。与非病例报告相比，开发了一个由九个编码组成的组合，其敏感性为74%，特异性为37%。我们得出结论，仅靠莱姆病的行政管理编码在马里兰州识别莱姆病病例的能力较低。对某些编码进行分组提高了敏感性，但我们的结果表明，对于像莱姆病这样具有复杂表现的疾病，仅靠行政管理编码并不是一种可行的监测替代方法。
