Pediatric Emergency Medicine, Sutter Medical Center Sacramento, Sacramento, CA, USA.
Instituto Nacional de Salud Pública, Centro de Investigación en Salud Poblacional, Cuernavaca, Morelos, Mexico.
BMC Med Res Methodol. 2018 Nov 22;18(1):149. doi: 10.1186/s12874-018-0589-4.
Bronchiolitis is a common respiratory disorder in children. Although there are specific ICD-9-CM diagnosis codes for bronchiolitis, the illness is often coded using broader diagnosis codes. This creates the potential for subject misclassification if researchers rely on specific diagnosis codes when assembling retrospective cohorts. Here we challenge the common research practice of relying on specific diagnosis codes for bronchiolitis.
We examined the use of diagnosis codes for the first episode of bronchiolitis, bronchitis, acute asthma, and bronchospasm and wheezing, in children younger than six and 24 months in the State of California Medic-Aid database. We categorized codes as narrow or broad diagnosis codes. We compared patient, geographic, and temporal characteristics of the different diagnoses codes.
We identified visits from 48,732 children for first episode of wheezing illness. We retained 48,269 who had the diagnosis codes and data of interest. Diagnosis codes for acute asthma were widely used, even in children younger than six months in whom a diagnosis code for bronchiolitis would have been anticipated. The temporal pattern was similar across all diagnoses. Antipyretics were prescribed more often in those with diagnosis codes for bronchiolitis and bronchitis. Other statistically significant differences were too small to usefully distinguish the groups. There was substantial geographic variability in the diagnosis codes selected.
Users of Medic-Aid administrative data should generally favor broad rather than narrow definitions of bronchiolitis and should perform sensitivity analysis comparing broad and narrow definitions.
细支气管炎是儿童常见的呼吸道疾病。虽然有特定的 ICD-9-CM 诊断代码用于细支气管炎，但该疾病通常使用更广泛的诊断代码进行编码。如果研究人员在组装回顾性队列时依赖特定的诊断代码，这就存在潜在的主题分类错误。在这里，我们对依赖特定的细支气管炎诊断代码的常见研究实践提出质疑。
我们检查了在加利福尼亚州医疗补助数据库中，6 个月和 24 个月以下儿童首次发生细支气管炎、支气管炎、急性哮喘和支气管痉挛伴喘息的诊断代码的使用情况。我们将代码分为狭义或广义诊断代码。我们比较了不同诊断代码的患者、地理和时间特征。
我们确定了 48732 名儿童因首次出现喘息疾病而就诊。我们保留了 48269 名有诊断代码和感兴趣数据的儿童。急性哮喘的诊断代码被广泛使用，即使是在预期会有细支气管炎诊断代码的 6 个月以下的儿童中也是如此。所有诊断的时间模式都相似。在有细支气管炎和支气管炎诊断代码的患者中，更常开具退烧药。其他具有统计学意义的差异太小，无法有效地区分这些组。诊断代码的选择存在显著的地理差异。
医疗补助管理数据的使用者通常应该倾向于使用广义而不是狭义的细支气管炎定义，并进行广义和狭义定义之间的敏感性分析。
