Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, USA
Colorado Department of Public Health and Environment, Denver, Colorado, USA.
Inj Prev. 2021 Mar;27(S1):i27-i34. doi: 10.1136/injuryprev-2019-043520.
In October 2015, discharge data coding in the USA shifted to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), necessitating new indicator definitions for drug overdose morbidity. Amid the drug overdose crisis, characterising discharge records that have ICD-10-CM drug overdose codes can inform the development of standardised drug overdose morbidity indicator definitions for epidemiological surveillance.
Eight states submitted aggregated data involving hospital and emergency department (ED) discharge records with ICD-10-CM codes starting with T36-T50, for visits occurring from October 2015 to December 2016. Frequencies were calculated for (1) the position within the diagnosis billing fields where the drug overdose code occurred; (2) primary diagnosis code grouped by ICD-10-CM chapter; (3) encounter types; and (4) intents, underdosing and adverse effects.
Among all records with a drug overdose code, the primary diagnosis field captured 70.6% of hospitalisations (median=69.5%, range=66.2%-76.8%) and 79.9% of ED visits (median=80.7%; range=69.8%-88.0%) on average across participating states. The most frequent primary diagnosis chapters included injury and mental disorder chapters. Among visits with codes for drug overdose initial encounters, subsequent encounters and sequelae, on average 94.6% of hospitalisation records (median=98.3%; range=68.8%-98.8%) and 95.5% of ED records (median=99.5%; range=79.2%-99.8%), represented initial encounters. Among records with drug overdose of any intent, adverse effect and underdosing codes, adverse effects comprised an average of 74.9% of hospitalisation records (median=76.3%; range=57.6%-81.1%) and 50.8% of ED records (median=48.9%; range=42.3%-66.8%), while unintentional intent comprised an average of 11.1% of hospitalisation records (median=11.0%; range=8.3%-14.5%) and 28.2% of ED records (median=25.6%; range=20.8%-40.7%).
Results highlight considerations for adapting and standardising drug overdose indicator definitions in ICD-10-CM.
2015 年 10 月，美国的出院数据编码转为采用《国际疾病分类》第 10 次修订版临床修订本（ICD-10-CM），这就需要对药物过量发病率的指标重新定义。在药物过量危机期间，对具有 ICD-10-CM 药物过量代码的出院记录进行特征描述，可以为制定标准化的药物过量发病率指标定义提供信息，以进行流行病学监测。
八个州提交了涉及 2015 年 10 月至 2016 年 12 月期间的医院和急诊（ED）出院记录的汇总数据，这些记录的 ICD-10-CM 代码以 T36-T50 开头。对以下内容进行了计算：（1）药物过量代码出现在诊断计费字段中的位置；（2）按 ICD-10-CM 章节分组的主要诊断代码；（3）就诊类型；以及（4）意图、剂量不足和不良反应。
在所有具有药物过量代码的记录中，主要诊断字段平均捕获了 70.6%的住院记录（中位数=69.5%，范围=66.2%-76.8%）和 79.9%的 ED 就诊记录（中位数=80.7%；范围=69.8%-88.0%）。最常见的主要诊断章节包括伤害和精神障碍章节。在药物过量初始就诊、后续就诊和后遗症就诊的就诊中，平均有 94.6%的住院记录（中位数=98.3%；范围=68.8%-98.8%）和 95.5%的 ED 记录（中位数=99.5%；范围=79.2%-99.8%）代表初始就诊。在具有任何意图、不良反应和剂量不足药物过量代码的记录中，不良反应平均占住院记录的 74.9%（中位数=76.3%；范围=57.6%-81.1%）和 ED 记录的 50.8%（中位数=48.9%；范围=42.3%-66.8%），而非故意意图平均占住院记录的 11.1%（中位数=11.0%；范围=8.3%-14.5%）和 ED 记录的 28.2%（中位数=25.6%；范围=20.8%-40.7%）。
研究结果强调了在 ICD-10-CM 中调整和标准化药物过量指标定义需要考虑的因素。
