scholarly journals Incidence Estimation in Post-ICU Populations: Challenges and Possible Solutions When Using Claims Data

2020 ◽  
Vol 82 (S 02) ◽  
pp. S101-S107
Author(s):  
Magdalena Brandl ◽  
Christian Apfelbacher ◽  
Annette Weiß ◽  
Susanne Brandstetter ◽  
Sebastian Edgar Baumeister
Keyword(s):  
Intensive Care ◽  
Competing Risks ◽  
Claims Data ◽  
International Classification Of Diseases ◽  
Interval Censoring ◽  
Competing Risk ◽  
Internal Validation ◽  
Exact Date ◽  
Classification Of Diseases ◽  
Icu Treatment

Abstract Background New or worsening cognitive, physical and/or mental health impairments after acute care for critical illness are referred to as “post-intensive care syndrome” (PICS). Little is known about the incidence of its components, since it is challenging to recruit patients after intensive care unit (ICU) treatment for observational studies. Claims data are particularly suited to achieve incidence estimates in difficult-to-recruit groups. However, some limitations remain when using claims data for empirical research on the outcome of ICU treatment. The objective of this article is to describe three challenges and possible solutions for the estimation of the incidence of PICS based on claims data Methodological challenges: The presence of competing risk by death, investigating a syndrome and dealing with interval censoring First, in (post) ICU populations the assumption of independence between the event of interest (diagnosis of PICS component) and the competing event (death) is violated. Competing risk is an event whose occurrence precludes the event of interest to be observed, and in ICU populations, death is a frequent secondary event. Methods that estimate incidence in the presence of competing risks are well-established but have not been applied to the scenario described above. Second, PICS is a complex syndrome and represented by various ICD-10 (International Classification of Diseases, 10th Revision) disease codes. The operationalization of this syndrome (case identification) and the validation of cases are particularly challenging. Third, another major challenge is that the exact date of the event of interest is not available in claims data. It is only known that the event occurred within a certain interval. This feature is called interval censoring. Recently, methods have been developed that address informative censoring due to competing risks in the presence of interval censoring. We will discuss how these methods could be used to tackle the problem when estimating PICS components. Alternatively, it could be possible to assign an exact date for each diagnosis by combining the diagnosis with the exact date of prescriptions of the respective medicines and/or medical services. Conclusion Estimating incidence in post-ICU populations entails various methodological issues when using claims data. Investigators need to be aware of the presence of competing risks. The application of internal validation criteria to operationalize the event of interest is crucial to achieve reliable incidence estimates. The problem of interval censoring can be solved either by statistical methods or by combining information from different sources.

scholarly journals Use of Diagnosis Codes and/or Wound Culture Results for Surveillance of Surgical Site Infection after Mastectomy and Breast Reconstruction

2010 ◽  
Vol 31 (05) ◽  
pp. 544-547 ◽  
Author(s):  
Margaret A. Olsen ◽  
Victoria J. Fraser
Keyword(s):  
Surgical Site Infection ◽  
Claims Data ◽  
Breast Surgery ◽  
International Classification Of Diseases ◽  
Site Infection ◽  
Wound Culture ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Major Breast

We compared surveillance of surgical site infection (SSI) after major breast surgery by using a combination of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and microbiology-based surveillance. The sensitivity of the coding algorithm for identification of SSI was 87.5%, and the sensitivity of wound culture for identification of SSI was 78.1%. Our results suggest that SSI surveillance can be reliably performed using claims data.

The prevalence of localised scleroderma in childhood assessed in the administrative claims data from the United States

2018 ◽  
Vol 4 (1) ◽  
pp. 77-78
Author(s):  
Timothy Beukelman ◽  
Fenglong Xie ◽  
Ivan Foeldvari
Keyword(s):  
United States ◽  
Systemic Sclerosis ◽  
Claims Data ◽  
International Classification Of Diseases ◽  
The United States ◽  
Administrative Claims ◽  
Administrative Claims Data ◽  
Diagnosis Codes ◽  
Classification Of Diseases

Juvenile localised scleroderma is believed an orphan autoimmune disease, which occurs 10 times more often than systemic sclerosis in childhood and is believed to have a prevalence of 1 per 100,000 children. To gain data regarding the prevalence of juvenile localised scleroderma, we assessed the administrative claims data in the United States using the International Classification of Diseases, Ninth Revision diagnosis codes. We found an estimated prevalence in each year ranging from 3.2 to 3.6 per 10,000 children. This estimate is significantly higher as found in previous studies.

Assessing the prevalence of juvenile systemic sclerosis in childhood using administrative claims data from the United States

2018 ◽  
Vol 3 (2) ◽  
pp. 189-190 ◽  
Author(s):  
Timothy Beukelman ◽  
Fenglong Xie ◽  
Ivan Foeldvari
Keyword(s):  
United States ◽  
Systemic Sclerosis ◽  
Claims Data ◽  
International Classification Of Diseases ◽  
The United States ◽  
Administrative Claims ◽  
Administrative Claims Data ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Juvenile Systemic Sclerosis

Juvenile systemic sclerosis is a very rare orphan disease. To date, only one publication has estimated the prevalence of juvenile systemic sclerosis using a survey of specialized physicians. We conducted a study of administrative claims data in the United States using the International Classification of Diseases, Ninth Revision diagnosis codes and found a prevalence of approximately 3 per 1,000,000 children. This estimate will inform the planning of prospective studies.

Laryngomalacia in Neonates Versus Older Infants: HCUP-KID Perspective

2020 ◽  
Vol 59 (7) ◽  
pp. 679-685
Author(s):  
Michele M. Carr ◽  
Jad Ramadan ◽  
Emma Bauer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Neonatal Intensive Care ◽  
International Classification Of Diseases ◽  
Classification Of Diseases ◽  
Cost Utilization ◽  
Inpatient Database ◽  
Total Charges

This study evaluated the hospital course for neonates and older infants with a diagnosis of laryngomalacia (LM). Data came from the 2016 Kids’ Inpatient Database of the Healthcare Cost Utilization Project. A total of 6537 children aged <1 year with a diagnosis of LM (International Classification of Diseases, 10th Revision, code Q31.5) were identified: 2212 neonates and 4325 non-neonates. Neonates had a higher mortality rate, 1.31% versus 0.72% in older infants, had more diagnoses (median 9 vs 7) and procedures (mean 85.24 vs 21.83), longer length of stay (median 10 vs 4 days), and higher total charges (median US$65 722 vs US$25 582). A total of 23.3% of neonates born during the admission and diagnosed with LM had undergone laryngoscopy. Second airway lesions were present in 12.33% of neonates and 15.77% of older infants. It appears that neonates are being discharged with a diagnosis of LM without laryngoscopy. Neonatal intensive care unit and newborn nursery policies should require visualization of the larynx prior to diagnosis of LM.

Development and Validation of a Pediatric Comorbidity Index

2020 ◽  
Author(s):  
Jenny W Sun ◽  
Florence T Bourgeois ◽  
Sebastien Haneuse ◽  
Sonia Hernández-Díaz ◽  
Joan E Landon ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
International Classification Of Diseases ◽  
Epidemiologic Studies ◽  
Internal Validation ◽  
Confounding Bias ◽  
Classification Of Diseases ◽  
Utilization Data ◽  
Comorbidity Scores ◽  
Comorbidity Index

Abstract Comorbidity scores are widely used to help address confounding bias in nonrandomized studies conducted within healthcare databases, but existing scores were developed to predict all-cause mortality in adults and may not be appropriate for use in pediatric studies. We developed and validated a pediatric comorbidity index, using healthcare utilization data from the tenth revision of the International Classification of Diseases. Within the MarketScan database, pediatric patients (&lt;18 years) continuously enrolled between October 1, 2015-September 30, 2017 were identified. Logistic regression was used to predict the 1-year risk of hospitalization based on 27 predefined conditions and empirically-identified conditions derived from the most prevalent diagnoses among patients with the outcome. A single numerical index was created by assigning weights to each condition based on its beta coefficient. We conducted internal validation of the index and compared its performance to existing adult scores. The pediatric comorbidity index consisted of 24 conditions and achieved a c-statistic of 0.718 (95% confidence interval [CI] 0.714, 0.723). The index oasutperformed existing adult scores in a pediatric population (c-statistics ranging from 0.522 to 0.640). The pediatric comorbidity index provides a summary measure of disease burden and can be used for risk adjustment in epidemiologic studies of pediatric patients.

scholarly journals Severe COVID-19 among patients with asthma and COPD: a report from the Swedish National Airway Register

2021 ◽  
Vol 15 ◽  
pp. 175346662110497
Author(s):  
Johanna Karlsson Sundbaum ◽  
Lowie E.G.W. Vanfleteren ◽  
Jon R. Konradsen ◽  
Fredrik Nyberg ◽  
Ann Ekberg-Jansson ◽  
...  
Keyword(s):  
Intensive Care ◽  
Large Population ◽  
International Classification Of Diseases ◽  
Death Certificates ◽  
Classification Of Diseases ◽  
National Patient ◽  
Icd 10 ◽  
Discharge From Hospital ◽  
Related Mortality

Background: Patients with obstructive lung diseases may be at risk of hospitalization and/or death due to COVID-19. Aim: To estimate the frequency of severe COVID-19, and COVID-19-related mortality in a well-defined large population of patients with asthma and chronic inflammatory lung disease (COPD). Further to assess the frequency of asthma and COPD as registered comorbidities at discharge from hospital, and in death certificates. Methods: At the start of the pandemic, the Swedish National Airway Register (SNAR) included 271,404 patients with a physician diagnosis of asthma and/or COPD. In September 2020, after the first COVID-19 wave in Sweden, the database was linked with the National Patient Register (NPR), the Swedish Intensive Care Register and the Swedish Cause of Death Register, which all provide data about COVID-19 based on International Classification of Diseases (ICD-10) codes. Severe COVID-19 was defined as hospitalization and/or intensive care or death due to COVID-19. Results: Among patients in SNAR, 0.5% with asthma, and 1.2% with COPD were identified with severe COVID-19. Among patients  < 18 years with asthma, only 0.02% were severely infected. Of hospitalized adults, 14% with asthma and 29% with COPD died. Further, of patients in SNAR, 56% with asthma and 81% with COPD were also registered in the NPR, while on death certificates the agreement was lower (asthma 24% and COPD 71%). Conclusion: The frequency of severe COVID-19 in asthma and COPD was relative low. Mortality for those hospitalized was double as high in COPD compared to asthma. Comorbid asthma and COPD were not always identified among patients with severe COVID-19.

Epidemiology of Traumatic Brain Injury After Small-Wheeled Vehicle Trauma in Utah

Neurosurgery ◽  
2015 ◽  
Vol 77 (6) ◽  
pp. 927-930 ◽  
Author(s):  
Sarah Majercik ◽  
Suzanne Day ◽  
Mark H. Stevens ◽  
Joel D. MacDonald ◽  
Joseph Bledsoe
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Injuries ◽  
International Classification Of Diseases ◽  
The United States ◽  
Helmet Use ◽  
Classification Of Diseases ◽  
Recreational Use ◽  
Wheeled Vehicles ◽  
Neurosurgical Intervention

BACKGROUND: Recreational use of small-wheeled vehicles (SWVs), which include skateboards, longboards, nonmotorized scooters, ice skates, and roller skates or rollerblades, results in numerous injuries in the United States. OBJECTIVE: To describe the nature and severity of traumatic brain injuries (TBIs) that result from the use of SWVs in Utah. METHODS: Patients who were admitted to any Utah hospital after a SWV-related injury from 2001 through 2010 were identified from the Utah State Trauma Registry. Patients who sustained TBI were identified by International Classification of Diseases, Ninth Revision, codes. RESULTS: Of 907 patients admitted with SWV injury, 392 (43%) had a TBI (85% male). Their mean age was 19.8 ± 0.5 years, including 234 (60%) aged ⩽18 and 119 (30%) aged 19 to 29. Most patients sustained TBI while using a skate- or longboard (87%). Mean Glasgow Coma Scale score in the emergency department was 12.8 ± 0.2. Thirty-nine percent were admitted to an intensive care unit, and 6% (23) underwent emergent neurosurgical intervention. Thirty-three (8.4%) patients had a concussion; the rest had nonoperative intracranial hemorrhage. Among patients for whom helmet use data were available, 8 out of 291 (2.7%) patients with TBI were wearing a helmet, whereas 24 out of 190 (12.6%) non-TBI patients were wearing helmets (P &lt; .001). Overall mortality was higher in TBI patients than in non-TBI patients (2.3% vs 0.2%, P = .003). CONCLUSION: Young people, especially males, who ride SWVs in Utah are at risk for serious TBI, admission to the intensive care unit, neurosurgical intervention, and death. Helmet use in these patients is likely rare, but may reduce the risk of TBI and death.

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