scholarly journals Many people admitted to hospital with a provisional diagnosis of nonserious back pain are subsequently found to have serious pathology as the underlying cause

2022 ◽  
Author(s):  
Alla Melman ◽  
Chris G. Maher ◽  
Chris Needs ◽  
Gustavo C. Machado
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Hospital Admissions ◽  
Spinal Fractures ◽  
Final Diagnosis ◽  
Snomed Ct ◽  
Provisional Diagnosis ◽  
Diagnostic Codes ◽  
Virtual Care ◽  
Icd 10

AbstractTo determine the proportion of patients admitted to the hospital for back pain who have nonserious back pain, serious spinal, or serious other pathology as their final diagnosis. The proportion of nonserious back pain admissions will be used to plan for future ‘virtual hospital’ admissions. Electronic medical record data between January 2016 and September 2020 from three emergency departments (ED) in Sydney, Australia were used to identify inpatient admissions. SNOMED-CT-AU diagnostic codes were used to select ED patients aged 18 and older with an admitting diagnosis related to nonserious back pain. The inpatient discharge diagnosis was determined from the primary ICD-10-AM codes by two independent clinician-researchers. Inpatient admissions were then analysed by sociodemographic and hospital admission variables. A total of 38.1% of patients admitted with a provisional diagnosis of nonserious back pain were subsequently diagnosed with a specific pathology likely unsuitable for virtual care; 14.2% with a serious spinal pathology (e.g., fracture and infection) and 23.9% a serious pathology beyond the lumbar spine (e.g., pathological fracture and neoplasm). A total of 57% of admissions were identified as nonserious back pain, likely suitable for virtual care. A challenge for implementing virtual care in this setting is screening for patients with serious pathology. Protocols need to be developed to reduce the risk of patients being admitted to virtual hospitals with serious pathology as the cause of their back pain. Key Points• Among admitted patients provisionally diagnosed in ED with non-serious back pain, 38.1% were found to have ‘serious spinal pathologies’ or ‘serious pathologies beyond the lumbar spine’ at discharge.• Spinal fractures were the most common serious spinal pathology, accounting for 9% of all provisional ‘non-serious back pain’ admissions from ED.• 57% of back pain admissions were confirmed to be non-serious back pain and may be suitable to virtual hospital care; the challenge is discriminating these patients from those with serious pathology.

scholarly journals Visualisation and optimisation of alcohol-related hospital admissions ICD-10 codes in Welsh e-cohort data

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Laszlo Trefan ◽  
Ashley Akbari ◽  
Jennifer Siân Morgan ◽  
Daniel Mark Farewell ◽  
David Fone ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Accurate Determination ◽  
Rate Sensitivity ◽  
Misclassification Rate ◽  
Care Utilization ◽  
Diagnostic Codes ◽  
Cohort Data ◽  
Icd 10 ◽  
Excessive Consumption

IntroductionThe excessive consumption of alcohol is detrimental to long term health and increases the likelihood of hospital admission. However, definitions of alcohol-related hospital admission vary, giving rise to uncertainty in the effect of alcohol on alcohol-related health care utilization. ObjectivesTo compare diagnostic codes on hospital admission and discharge and to determine the ideal combination of codes necessary for an accurate determination of alcohol-related hospital admission. MethodsRoutine population-linked e-cohort data were extracted from the Secure Anonymised Information Linkage (SAIL) Databank containing all alcohol-related hospital admissions (n,= 92,553) from 2006 to 2011 in Wales, United Kingdom. The distributions of the diagnostic codes recorded at admission and discharge were compared. By calculating a misclassification rate (sensitivity-like measure) the appropriate number of coding fields to examine for alcohol-codes was established. ResultsThere was agreement between admission and discharge codes. When more than ten coding fields were used the misclassification rate was less than 1%. ConclusionWith the data at present and alcohol-related codes used, codes recorded at admission and discharge can be used equivalently to identify alcohol-related admissions. The appropriate number of coding fields to examine was established: fewer than ten is likely to lead to under-reporting of alcohol-related admissions. The methods developed here can be applied to other medical conditions that can be described using a certain set of diagnostic codes, each of which can be a known sole cause of the condition and recorded in multiple positions in e-cohort data.

scholarly journals Has the incidence of empyema in Scottish children continued to increase beyond 2005?

2014 ◽  
Vol 100 (3) ◽  
pp. 255-258 ◽  
Author(s):  
Stuart Nath ◽  
Matt Thomas ◽  
David Spencer ◽  
Steve Turner
Keyword(s):  
Hospital Admissions ◽  
Incidence Rate Ratio ◽  
Pneumococcal Vaccination ◽  
International Classification Of Diseases ◽  
Diagnostic Codes ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
The Relationship ◽  
Insight Into

BackgroundThe incidence of empyema increased dramatically in children during the 1990s and early 2000s. We investigated the relationship between changes in the incidence of childhood empyema in Scotland following the 2006 introduction of routine heptavalent conjugate pneumococcal vaccination (PCv-7) and the 2010 introduction of the 13-valent (PCV-13) vaccine.MethodsThis was a whole-population study of Scottish hospital admissions between 1981 and 2013 using ICD (International Classification of Diseases)-9 and ICD-10 diagnostic codes for empyema. The number of admissions for pneumonia and croup was also captured to give insight into secular trends in admissions with other related and unrelated respiratory presentations.ResultsThere were 217 admissions with empyema between 1981 and 2005 (mean incidence 9 cases/million/year) and 323 between 2006 and 2013 (mean incidence 47 cases/million/year), p<0.001. The introduction of conjugate vaccines in 2006 was associated with an overall increase in admissions for empyema of 2.0 (95% CI 1.4 to 2.8) per 100 000 children, however, the incidence rate ratio for empyema admission between 2010 and 2013 was lower relative to 2006–2009 (0.78 (95% CI 0.63 to 0.98)). Secular changes in pneumonia, but not croup, were comparable with those for empyema.ConclusionsThe incidence of empyema in Scottish children initially rose in children aged 1 to 9 years after the introduction of routine conjugate pneumococcal vaccination, however, empyema incidence has fallen since 2010 when the PCV-13 was introduced.

scholarly journals Using ICD-10 Diagnostic Codes to Identify ‘Missing’ Paediatric Patients During Nationwide COVID-19 Lockdown in Oxfordshire, UK

2021 ◽  
Author(s):  
James E.G. Charlesworth ◽  
Rhian Bold ◽  
Rani Pal
Keyword(s):  
Hospital Admissions ◽  
Observational Cohort Study ◽  
Urgent Care ◽  
Accidental Injury ◽  
The Past ◽  
Diagnostic Codes ◽  
Icd 10 ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study ◽  
At Home

Abstract Objective: To identify diagnoses which were ‘missing’ amongst paediatric inpatients during the UK’s first national lockdown, compared with the same period over the past five years.Study design: A retrospective observational cohort study of all children (0-15 years) attending for urgent care across Oxfordshire, during the first UK lockdown in 2020, compared to matched dates in 2015-2019. This covers two paediatric hospitals providing secondary care, one with tertiary services. Main outcomes: Changes in numbers of patients attending and inpatient diagnoses (using ICD-10 classification) during the first 2020 lockdown, compared with the previous five years.Results: Total ED attendances (n=4030) and hospital admissions (n=1416) during the first UK lockdown were reduced by 56.8% and 59.4%, respectively, compared to attendances/admissions in 2015-2019 (5-year mean n=7446.8 and n=2491.6, respectively). Proportions of patients admitted from ED and length of stay were similar in lockdown to 2015-2019. Significantly greater numbers of neoplasms were diagnosed during lockdown than the same period in 2015-2019 (p= 0.0123). 80% of diagnoses ‘missing’ during lockdown were categorised as infectious diseases or their sequelae, whilst 20% were non-specific pains/aches/malaise and accidental injury/poisonings. Conclusions: Using standardised ICD-10 codes as a measure of diagnostic activity between years; ‘missing’ diagnoses can be identified. Our findings may suggest parents are supervising infectious illness at home or had anxieties about hospital attendance, with self-limited low-morbidity disease. Prospective studies should establish if parents/carers are adequately supported in caring for their children at home, and that access and referral pathways are appropriate where children have concerning clinical features.

Severe low back pain with mild leg symptoms due to lumbar spine stenosis

2021 ◽  
pp. 1-4
Author(s):  
Ryo Kanematsu ◽  
Junya Hanakita ◽  
Toshiyuki Takahashi ◽  
Manabu Minami ◽  
Kazuhiro Miyasaka ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Low Back

scholarly journals Understanding Suicide in Our Community through the Lens of the Pediatric ICU: An Epidemiological Review (2011–2017) of One Midwestern City in the US

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 59
Author(s):  
Andrew Kampfschulte ◽  
Matthew Oram ◽  
Alejandra M. Escobar Vasco ◽  
Brittany Essenmacher ◽  
Amy Herbig ◽  
...  
Keyword(s):  
Local Community ◽  
Hospital Admissions ◽  
Age Groups ◽  
Care Facility ◽  
Pediatric Intensive Care ◽  
High Volume ◽  
Temporal Variables ◽  
Geographical Regions ◽  
Icd 10 ◽  
Pediatric Icu

Suicide frequency has tripled for some pediatric age groups over the last decade, of which, serious attempts result in pediatric intensive care unit (PICU) admissions. We paired clinical, aggregate geospatial, and temporal demographics to understand local community variables to determine if epidemiological patterns emerge that associate with risk for PICU admission. Data were extracted at an urban, high-volume, quaternary care facility from January 2011 to December 2017 via ICD 10 codes associated with suicide. Clinical, socioeconomic, geographical, and temporal variables were reviewed. In total, 1036 patients over the age of 9 were included, of which n = 161 were PICU admissions. Females represented higher proportions of all suicide-related hospital admissions (67.9%). Looking at race/ethnicity, PICU admissions were largely Caucasian (83.2%); Blacks and Hispanics had lower odds of PICU admissions (OR: 0.49; 0.17, respectively). PICU-admitted patients were older (16.0 vs. 15.5; p = 0.0001), with lower basal metabolic index (23.0 vs. 22.0; p = 0.0013), and presented in summer months (OR: 1.51, p = 0.044). Time-series decomposition showed seasonal peaks in June and August. Local regions outside the city limits identified higher numbers of PICU admissions. PICUs serve discrete geographical regions and are a source of information, when paired with clinical geospatial/seasonal analyses, highlighting clinical and societal risk factors associated with PICU admissions.

scholarly journals Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis

2020 ◽  
Vol 41 (S1) ◽  
pp. s32-s32
Author(s):  
Ebbing Lautenbach ◽  
Keith Hamilton ◽  
Robert Grundmeier ◽  
Melinda Neuhauser ◽  
Lauri Hicks ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Predictive Value ◽  
Gold Standard ◽  
Chart Review ◽  
Acute Bronchitis ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Diagnostic Codes ◽  
Icd 10 ◽  
The Impact

Background: Antibiotic resistance has increased at alarming rates, driven predominantly by antibiotic overuse. Although most antibiotic use occurs in outpatients, antimicrobial stewardship programs have primarily focused on inpatient settings. A major challenge for outpatient stewardship is the lack of accurate and accessible electronic data to target interventions. We sought to develop and validate an electronic algorithm to identify inappropriate antibiotic use for outpatients with acute bronchitis. Methods: This study was conducted within the University of Pennsylvania Health System (UPHS). We used ICD-10 diagnostic codes to identify encounters for acute bronchitis at any outpatient UPHS practice between March 15, 2017, and March 14, 2018. Exclusion criteria included underlying immunocompromising condition, other comorbidity influencing the need for antibiotics (eg, emphysema), or ICD-10 code at the same visit for a concurrent infection (eg, sinusitis). We randomly selected 300 (150 from academic practices and 150 from nonacademic practices) eligible subjects for detailed chart abstraction that assessed patient demographics and practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for assessment of the electronic algorithm. Because antibiotic use is not indicated for this study population, appropriateness was assessed based upon whether an antibiotic was prescribed or not. Results: Of 300 subjects, median age was 61 years (interquartile range, 50–68), 62% were women, 74% were seen in internal medicine (vs family medicine) practices, and 75% were seen by a physician (vs an advanced practice provider). On chart review, 167 (56%) subjects received an antibiotic. Of these subjects, 1 had documented concern for pertussis and 4 had excluding conditions for which there were no ICD-10 codes. One received an antibiotic prescription for a planned dental procedure. Thus, based on chart review, 161 (54%) subjects received antibiotics inappropriately. Using the electronic algorithm based on diagnostic codes, underlying and concurrent conditions, and prescribing data, the number of subjects with inappropriate prescribing was 170 (56%) because 3 subjects had antibiotic prescribing not noted based on chart review. The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were the following: sensitivity, 100% (161 of 161); specificity, 94% (130 of 139); positive predictive value, 95% (161 of 170); and negative predictive value, 100% (130 of 130). Conclusions: For outpatients with acute bronchitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. This algorithm could be used to efficiently assess prescribing among practices and individual clinicians. The impact of interventions based on this algorithm should be tested in future studies.Funding: NoneDisclosures: None

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