Bowyer Stuart A, Booth John, Key Daniel, Pissaridou Eleni, Bryant William A, Hemingway Harry, Sebire Neil J
Data Research, Innovation and Virtual Environments (DRIVE) Unit, Great Ormond Street Hospital, London United Kingdom.
NIHR GOSH Biomedical Research Centre, London, United Kingdom.
PLoS One. 2025 May 6;20(5):e0322997. doi: 10.1371/journal.pone.0322997. eCollection 2025.
In adult practice there is recognition that average patient complexity is increasing, with a greater proportion of patients having multiple diagnoses or comorbidities. This study aims to examine whether there has been a change in number of recorded coexisting diagnoses per patient over a 24-year period for children attending as in-patients to a specialist children's hospital in England.
Following all in-patient admissions, patient episodes are allocated specific diagnosis codes (ICD-10) by a specialist clinical coding team according to standard NHS criteria and guidance. We examine the number of coexisting diagnoses allocated per patient admission over a 24-year period.
From a total of 278,579 overnight in-patient admissions during the study period (2000-2023) there were 1,023,276 ICD-10 patient diagnoses. The mean number of diagnoses per admission increased from 2.72 to 10.43 over the period (Kendall's tau statistic of 0.93; p-value < 0.001), an increase of 284% (95% confidence interval 275% - 293%).
Over recent decades, the recorded complexity of patients attending a specialist children's hospital appear to have increased significantly, with an almost 3-fold increase in the number of coexisting diagnoses present per admission. The cause of this finding cannot be determined from the data; however, it appears to be gradual and consistent, and across all speciality areas suggesting biological or referral factors rather than artefactual coding issues. Recognition of such a trend is important when interpreting retrospective data for AI, research, and planning purposes.
在成人医疗实践中，人们认识到患者的平均复杂程度在增加，患有多种诊断或合并症的患者比例更高。本研究旨在调查在24年期间，入住英国一家专科儿童医院的儿童患者，其每位患者记录的共存诊断数量是否发生了变化。
在所有住院患者入院后，由专业临床编码团队根据英国国家医疗服务体系（NHS）的标准和指南为患者病历分配特定的诊断代码（ICD - 10）。我们研究了24年期间每位患者入院时分配的共存诊断数量。
在研究期间（2000 - 2023年），共有278,579例过夜住院患者，有1,023,276个ICD - 10患者诊断。在此期间，每次入院的平均诊断数量从2.72增加到10.43（肯德尔tau统计量为0.93；p值<0.001），增加了284%（95%置信区间为275% - 293%）。
近几十年来，入住专科儿童医院的患者记录的复杂程度似乎显著增加，每次入院时共存诊断的数量几乎增加了3倍。这一发现的原因无法从数据中确定；然而，它似乎是渐进且一致的，并且在所有专科领域都存在，这表明是生物学或转诊因素而非人为编码问题。在为人工智能、研究和规划目的解释回顾性数据时，认识到这种趋势很重要。
