Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Health Serv Res. 2021 Apr;56(2):225-234. doi: 10.1111/1475-6773.13615. Epub 2020 Dec 29.
To create definitions for complications for 16 serious pediatric conditions using the International Classification of Diseases, 10th Revision, Clinical Modification or Procedure Coding System (ICD-10-CM/PCS), and to assess whether complication rates are similar to those measured with ICD-9-CM/PCS.
The Healthcare Cost and Utilization Project State Emergency Department and Inpatient Databases from five states between 2014 and 2017 were used to identify cases and assess complication rates. Incidences were calculated using population counts from the 5-year American Community Survey.
DATA COLLECTION/EXTRACTION METHODS: Patients were identified by the presence of a diagnosis code for one of the 16 serious conditions. Only the first encounter for a given condition by a patient was included. Encounters resulting in transfer were excluded as the presence of complications was unknown.
We defined complications using data elements routinely available in administrative databases including ICD-10-CM/PCS codes. The definitions were adapted from ICD-9-CM/PCS using general equivalence mappings and refined using consensus opinion. We included 16 serious conditions: appendicitis, bacterial meningitis, compartment syndrome, new-onset diabetic ketoacidosis (DKA), ectopic pregnancy, empyema, encephalitis, intussusception, mastoiditis, myocarditis, orbital cellulitis, ovarian torsion, sepsis, septic arthritis, stroke, and testicular torsion. Using data from children under 18 years, we compared incidences and complication rates across the ICD-10-CM/PCS transition for each condition using interrupted time series.
There were 61 314 ED visits for a serious condition; the most common was appendicitis (n = 37 493). Incidence rates for each condition were not significantly different across the ICD-10-CM/PCS transition for 13/16 conditions. Three differed: empyema (increased 42%), orbital cellulitis (increased 60%), and sepsis (increased 26%). Complication rates were not significantly different for each condition across the ICD-10-CM/PCS transition, except appendicitis (odds ratio 0.62, 95% CI 0.57-0.68), DKA (OR 3.79, 95% CI 1.92-7.50), and orbital cellulitis (OR 0.53, 95% CI 0.30-0.95).
For most conditions, incidences and complication rates were similar before and after the transition to ICD-10-CM/PCS codes, suggesting our system identifies complications of conditions in administrative data similarly using ICD-9-CM/PCS and ICD-10-CM/PCS codes. This system may be applied to screen for cases with complications and in health services research.
使用国际疾病分类第 10 版临床修订版或手术编码系统（ICD-10-CM/PCS）为 16 种严重儿科疾病创建并发症定义，并评估并发症发生率是否与 ICD-9-CM/PCS 测量的结果相似。
2014 年至 2017 年，来自五个州的医疗保健成本和利用项目州急诊和住院数据库被用于确定病例并评估并发症发生率。发病率是使用五年期美国社区调查的人口计数计算得出的。
数据收集/提取方法：通过一个或多个 16 种严重疾病的诊断代码来识别患者。仅包括患者首次就诊时的一种疾病。由于未知并发症的存在，将导致转移的就诊排除在外。
我们使用管理数据库中常规提供的数据元素来定义并发症，包括 ICD-10-CM/PCS 代码。这些定义是通过通用等价映射从 ICD-9-CM/PCS 改编而来的，并通过共识意见进行了改进。我们包括了 16 种严重疾病：阑尾炎、细菌性脑膜炎、筋膜室综合征、新发糖尿病酮症酸中毒（DKA）、宫外孕、脓胸、脑炎、肠套叠、乳突炎、心肌炎、眶蜂窝织炎、卵巢扭转、脓毒症、化脓性关节炎、中风和睾丸扭转。使用 18 岁以下儿童的数据，我们使用中断时间序列比较了每种疾病在 ICD-10-CM/PCS 过渡期间的发生率和并发症发生率。
急诊就诊有 61314 次严重疾病；最常见的是阑尾炎（n=37493）。在 ICD-10-CM/PCS 过渡期间，16 种疾病中有 13 种的每种疾病的发病率均无显著差异。有三种不同：脓胸（增加 42%）、眶蜂窝织炎（增加 60%）和脓毒症（增加 26%）。在 ICD-10-CM/PCS 过渡期间，每种疾病的并发症发生率没有显著差异，除了阑尾炎（比值比 0.62，95%置信区间 0.57-0.68）、DKA（比值比 3.79，95%置信区间 1.92-7.50）和眶蜂窝织炎（比值比 0.53，95%置信区间 0.30-0.95）。
对于大多数疾病，在向 ICD-10-CM/PCS 代码过渡前后，发病率和并发症发生率相似，这表明我们的系统使用 ICD-9-CM/PCS 和 ICD-10-CM/PCS 代码在管理数据中类似地识别出疾病的并发症。该系统可用于筛选有并发症的病例，并应用于卫生服务研究。
