Exploring in-hospital adverse drug events using ICD-10 codes

2014 ◽  
Vol 38 (4) ◽  
pp. 454 ◽  
Author(s):  
Sumit Parikh ◽  
Donna Christensen ◽  
Peter Stuchbery ◽  
Jenny Peterson ◽  
Anastasia Hutchinson ◽  
...  

Objective Adverse drug events (ADEs) during hospital admissions are a widespread problem associated with adverse patient outcomes. The ‘external cause’ codes in the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) provide opportunities for identifying the incidence of ADEs acquired during hospital stays that may assist in targeting interventions to decrease their occurrence. The aim of the present study was to use routine administrative data to identify ADEs acquired during hospital admissions in a suburban healthcare network in Melbourne, Australia. Methods Thirty-nine secondary diagnosis fields of hospital discharge data for a 1-year period were reviewed for ‘diagnoses not present on admission’ and assigned to the Classification of Hospital Acquired Diagnoses (CHADx) subclasses. Discharges with one or more ADE subclass were extracted for retrospective analysis. Results From 57 205 hospital discharges, 7891 discharges (13.8%) had at least one CHADx, and 402 discharges (0.7%) had an ADE recorded. The highest proportion of ADEs was due to administration of analgesics (27%) and systemic antibiotics (23%). Other major contributors were anticoagulation (13%), anaesthesia (9%) and medications with cardiovascular side-effects (9%). Conclusion Hospital data coded in ICD-10 can be used to identify ADEs that occur during hospital stays and also clinical conditions, therapeutic drug classes and treating units where these occur. Using the CHADx algorithm on administrative datasets provides a consistent and economical method for such ADE monitoring. What is known about the topic? Adverse drug events (ADEs) can result in several different physical consequences, ranging from allergic reactions to death, thereby posing a significant burden on patients and the health system. Numerous studies have compared manual, written incident reporting systems used by hospital staff with computerised automated systems to identify ADEs acquired during hospital admissions. Despite various approaches aimed at improving the detection of ADEs, they remain under-reported, as a result of which interventions to mitigate the effect of ADEs cannot be initiated effectively. What does this paper add? This research article demonstrates major methodological advances over comparable published studies looking at the effectiveness of using routine administrative data to monitor rates of ADEs that occur during a hospital stay and reviews the type of ADEs and their frequency patterns during patient admission. It also provides an insight into the effect of ADEs that occur within different hospital treating units. The method implemented in this study is unique because it uses a grouping algorithm developed for the Australian Commission on Safety and Quality in Health Care (ACSQHC) to identify ADEs not present on admission from patient data coded in ICD-10. This algorithm links the coded external causes of ADEs with their consequences or manifestations. ADEs identified through the use of programmed code based on this algorithm have not been studied in the past and therefore this paper adds to previous knowledge in this subject area. What are the implications for health professionals? Although not all ADEs can be prevented with current medical knowledge, this study can assist health professionals in targeting interventions that can efficiently reduce the rate of ADEs that occur during a hospital stay, and improve information available for future medication management decisions.

2018 ◽  
Vol 34 (12) ◽  
Author(s):  
Ana Cristina Martins ◽  
Fabíola Giordani ◽  
Lusiele Guaraldo ◽  
Gianni Tognoni ◽  
Suely Rozenfeld

Studies of adverse drug events (ADEs) are important in order not to jeopardize the positive impact of pharmacotherapy. These events have substantial impact on the population morbidity profiles, and increasing health system operating costs. Administrative databases are an important source of information for public health purposes and for identifying ADEs. In order to contribute to learning about ADE in hospitalized patients, this study examined the potential of applying ICD-10 (10th revision of the International Classification of Diseases) codes to a national database of the public health care system (SIH-SUS). The study comprised retrospective assessment of ADEs in the SIH-SUS administrative database, from 2008 to 2012. For this, a list of ICD-10 codes relating to ADEs was built. This list was built up by examining lists drawn up by other authors identified by bibliographic search in the MEDLINE and LILACS and consultations with experts. In Brazil, 55,604,537 hospital admissions were recorded in the SIH-SUS, between 2008 and 2012, of which 273,440 (0.49%) were related to at least one ADE. The proportions and rates seem to hold constant over the study period. Fourteen out of 20 most frequent ADEs were identified in codes relating to mental disorders. Intoxications figure as the second most frequently recorded group of ADEs in the SIH-SUS, comprising 76,866 hospitalizations. Monitoring of ADEs in administrative databases using ICD-10 codes is feasible, even in countries with information systems under construction, and can be an innovative tool to complement drug surveillance strategies in place in Brazil, as well as in others countries.


Author(s):  
Mackenzie A Hamilton ◽  
Andrew Calzavara ◽  
Scott D Emerson ◽  
Jeffrey C Kwong

Objective: Routinely collected health administrative data can be used to efficiently assess disease burden in large populations, but it is important to evaluate the validity of these data. The objective of this study was to develop and validate International Classification of Disease 10PthP revision (ICD -10) algorithms that identify laboratory-confirmed influenza or laboratory-confirmed respiratory syncytial virus (RSV) hospitalizations using population-based health administrative data from Ontario, Canada. Study Design and Setting: Influenza and RSV laboratory data from the 2014-15 through to 2017-18 respiratory virus seasons were obtained from the Ontario Laboratories Information System (OLIS) and were linked to hospital discharge abstract data to generate influenza and RSV reference cohorts. These reference cohorts were used to assess the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ICD-10 algorithms. To minimize misclassification in future studies, we prioritized specificity and PPV in selecting top-performing algorithms. Results: 83,638 and 61,117 hospitalized patients were included in the influenza and RSV reference cohorts, respectively. The best influenza algorithm had a sensitivity of 73% (95% CI 72% to 74%), specificity of 99% (95% CI 99% to 99%), PPV of 94% (95% CI 94% to 95%), and NPV of 94% (95% CI 94% to 95%). The best RSV algorithm had a sensitivity of 69% (95% CI 68% to 70%), specificity of 99% (95% CI 99% to 99%), PPV of 91% (95% CI 90% to 91%) and NPV of 97% (95% CI 97% to 97%). Conclusion: We identified two highly specific algorithms that best ascertain patients hospitalized with influenza or RSV. These algorithms may be applied to hospitalized patients if data on laboratory tests are not available, and will thereby improve the power of future epidemiologic studies of influenza, RSV, and potentially other severe acute respiratory infections.


2015 ◽  
Vol 31 (6) ◽  
pp. 390-396 ◽  
Author(s):  
Francois-André Allaert ◽  
Eric Benzenine ◽  
Catherine Quantin

Objective The objective was to describe the prevalence of venous thromboembolism, pulmonary embolism, and deep vein thrombosis among hospitalized patients and the percentages of those occurring during the hospital stays. Methods French DRG gave now the opportunity to investigate the frequency of venous thromboembolism occurring during the hospital stay. Statistics are issued from the national PMSI MCO databases encoded using the CIM10. Since 2010–2011 it is possible to differentiate the reason for hospital admission from the pathologies which secondly occurred. Any stay with the ICD-10 codes selected was considered as a hospital-occurred thrombosis unless it was the principal diagnosis of the first medical unit summary. To eliminate outpatient consultations or in day care, stays of <48 h were excluded. Results The results pertain to the 78,838,983 hospitalizations in France from 2005 to 2011 and on the 18,683,603 hospital stays in 2010–2011. The incidence of hospital stays came to 860,343 (1.09%) for venous thromboembolism, with 428,261 (0.543%) for deep vein thrombosis without pulmonary embolism and 432,082 (0.548%) for pulmonary embolism. It corresponds to an incidence of 189 per 100,000 inhabitants. Out of 100 hospital stays involving venous thromboembolism, for 40.3% venous thromboembolism was the cause of hospitalization whereas 59.7% can be considered to have occurred during hospital stay. These distributions are of 25.6 and 74.4% for deep vein thrombosis, respectively, 53.8 and 46.2% for pulmonary embolism. Conclusion The high proportion of hospital-occurred venous thromboembolism is an alarming situation that should question the quality of prevention and/or its effectiveness.


2014 ◽  
Vol 48 (4) ◽  
pp. 739-747 ◽  
Author(s):  
Fabiana Rossi Varallo ◽  
Synara de Oliveira Paim Guimarães ◽  
Samir Antonio Rodrigues Abjaude ◽  
Patricia de Carvalho Mastroianni

Objective: Identifying the main causes for underreporting of Adverse Drug Reaction (ADR) by health professionals. Method: A systematic review carried out in the following databases: LILACS, PAHO, SciELO, EMBASE and PubMed in the period between 1992 and 2012. Descriptors were used in the search for articles, and the identified causes of underreporting were analyzed according to the classification of Inman. Results: In total, were identified 149 articles, among which 29 were selected. Most studies were carried out in hospitals (24/29) for physicians (22/29), and pharmacists (10/29). The main causes related to underreporting were ignorance (24/29), insecurity (24/29) and indifference (23/29). Conclusion: The data show the eighth sin in underreporting, which is the lack of training in pharmacovigilance. Therefore, continuing education can increase adherence of professionals to the service and improve knowledge and communication of risks due to drug use.



2017 ◽  
Vol 24 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Ben Beck ◽  
Christina L Ekegren ◽  
Peter Cameron ◽  
Mark Stevenson ◽  
Rodney Judson ◽  
...  

Accurate coding of injury event information is critical in developing targeted injury prevention strategies. However, little is known about the validity of the most universally used coding system, the International Classification of Diseases (ICD-10), in characterising crash counterparts in pedal cycling events. This study aimed to determine the agreement between hospital-coded ICD-10-AM (Australian modification) external cause codes with self-reported crash characteristics in a sample of pedal cyclists admitted to hospital following bicycle crashes. Interview responses from 141 injured cyclists were mapped to a single ICD-10-AM external cause code for comparison with ICD-10-AM external cause codes from hospital administrative data. The percentage of agreement was 77.3% with a κ value of 0.68 (95% CI 0.61 to 0.77), indicating substantial agreement. Nevertheless, studies reliant on ICD-10 codes from administrative data should consider the 23% level of disagreement when characterising crash counterparts in cycling crashes.


2014 ◽  
Vol 21 (3) ◽  
pp. 547-557 ◽  
Author(s):  
Corinne M Hohl ◽  
Andrei Karpov ◽  
Lisa Reddekopp ◽  
Jürgen Stausberg

Author(s):  
Phil Murphy ◽  
Samuel Brown

Background with rationale There is evidence of a strong relationship between health (and mother’s health) and early educational attainment. With access to administrative data this relationship can be explored to greater depth for the UK. Main Aim To explore the effects of a pupil’s and their mother’s health (split into 22 categories) upon the pupil’s educational attainment through the use of administrative data. Methods/Approach Health events were found through hospital admissions and then converted into the World Health Organisation’s ICD-10 health events. Two year lags were also created for these health events. Probit and ordered probit analyses were then used to explore the effects of these health events on a binary pass/fail core subject indicator and on a teacher assessed grade for Maths, Science and English. Analysis was split by gender and keystage. Results Few of the health events affect the educational attainment of the pupil. The health of male pupils has little impact on education, with the mother’s health having a stronger impact. The mother’s past health events have the greatest impact upon the male pupil’s education. The male pupil’s past health effects keystage 2 pupils the most, with little effect for keystage 1 and 3 pupils. Female pupils’ health has little impact at keystage 1, with increasing importance at keystage 2 and 3. Mother’s health (including past health) seems to have the opposite effect, being more important at keystage 1 and less at keystage 2 and 3. The female pupil’s past health has a small but consistent impact across all keystages. Conclusion By splitting health into ICD-10 categories, the health events that affect education have been more clearly identified. Most importantly, however, is the contribution of administrative data, allowing for in-depth analysis of health on education.


2017 ◽  
Vol 27 (1) ◽  
pp. 24936
Author(s):  
Yasmin De Oliveira Machado Silva ◽  
Marina Guimarães Lima

Aims: To estimate the rate of hospital admissions due to adverse drug events under the Unified Public Health System in the State of Minas Gerais, Brazil, according to demographic variables, length of stay, medical specialty, and cause of hospitalization.Methods: Cross-sectional study with secondary data on hospital admissions paid for under the Unified Health System in Minas Gerais between 2012 and 2014. The incidence of hospitalizations for adverse drug events was calculated and expressed per 1,000 admissions. The total number of admissions and of hospitalizations for adverse drug events was described according to the patient’s gender and age, length of hospital stay, and the medical specialty. The frequencies of the different categories of the variables of interest were compared using the chi-square test and a 5% significance level.Results: The incidence of hospitalizations for adverse drug events was 25.9 per 1,000 admissions paid for by the Unified Public Health System. Men had a higher rate of hospitalizations for adverse drug events than women (2.7% vs. 2.4%). In terms of age, the highest rate of hospitalizations for adverse drug events was observed among individuals aged 60 years or older (3.4%) and the lowest rate was among children aged up to 9 years (0.6%). A higher rate of hospitalizations for adverse drug events was observed when the length of stay was 15 days or longer (7.6%) and in patients admitted from the psychiatric service (8.3%).Conclusions: Adverse drug events were an important cause of hospitalization under the Unified Public Health System in Minas Gerais between 2012 and 2014. Hospitalization for adverse drug events was associated with being male, being 60 years or older, having a longer hospital stay, and being admitted from the psychiatric service. Actions that promote pharmacovigilance in health institutions are necessary for the prevention of adverse drug events.


Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012223
Author(s):  
Jessica Magid-Bernstein ◽  
Setareh Salehi Omran ◽  
Neal S. Parikh ◽  
Alexander E. Merkler ◽  
Babak Navi ◽  
...  

Objective:To estimate the incidence of hospitalization for reversible cerebral vasoconstriction syndrome (RCVS), we identified RCVS-related hospital admissions across 11 U.S. states in 2016.Methods:We tested the validity of ICD-10 code I67.841 in 79 patients with hospital admissions for RCVS or other cerebrovascular diseases at one academic and one community hospital. After determining that this code had a sensitivity of 100% (95% CI, 82-100%) and a specificity of 90% (95% CI, 79-96%), we applied it to administrative data from the Healthcare Cost and Utilization Project on all ED visits and hospital admissions. Age- and sex-standardized RCVS incidence was calculated using census data. Descriptive statistics were used to analyze associated diagnoses.Results:Across 5,067,250 hospital admissions in our administrative data, we identified 222 patients with a discharge diagnosis of RCVS in 2016. The estimated annual age- and sex-standardized incidence of RCVS hospitalization was 2.7 (95% CI, 2.4-3.1) cases per million adults. Many patients had concomitant neurologic diagnoses, including subarachnoid hemorrhage (37%), ischemic stroke (16%), and intracerebral hemorrhage (10%). In the 90 days before the index admission, 97 patients had an ED visit and 34 patients a hospital admission, most commonly for neurologic, psychiatric, and pregnancy-related diagnoses. Following discharge from the RCVS hospital admission, 58 patients had an ED visit and 31 had a hospital admission, most commonly for neurologic diagnoses.Conclusions:Using population-wide data, we estimated the age- and sex-standardized incidence of hospitalization for RCVS in U.S. adults as approximately 3 per million per year.


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