Understanding the full burden of drowning: a retrospective, cross-sectional analysis of fatal and non-fatal drowning in Australia

ObjectivesThe epidemiology of fatal drowning is increasingly understood. By contrast, there is relatively little population-level research on non-fatal drowning. This study compares data on fatal and non-fatal drowning in Australia, identifying differences in outcomes to guide identification of the best practice in minimising the lethality of exposure to drowning.DesignA subset of data on fatal unintentional drowning from the Royal Life Saving National Fatal Drowning Database was compared on a like-for-like basis to data on hospital separations sourced from the Australian Institute of Health and Welfare’s National Hospital Morbidity Database for the 13-year period 1 July 2002 to 30 June 2015. A restrictive definition was applied to the fatal drowning data to estimate the effect of the more narrow inclusion criteria for the non-fatal data (International Classification of Diseases (ICD) codes W65-74 and first reported cause only). Incidence and ratios of fatal to non-fatal drowning with univariate and Χ2 analysis are reported and used to calculate case-fatality rates.SettingAustralia, 1 July 2002 to 30 June 2015.ParticipantsUnintentional fatal drowning cases and cases of non-fatal drowning resulting in hospital separation.Results2272 fatalities and 6158 hospital separations occurred during the study period, a ratio of 1:2.71. Children 0–4 years (1:7.63) and swimming pools (1:4.35) recorded high fatal to non-fatal ratios, whereas drownings among people aged 65–74 years (1:0.92), 75+ years (1:0.87) and incidents in natural waterways (1:0.94) were more likely to be fatal.ConclusionsThis study highlights the extent of the drowning burden when non-fatal incidents are considered, although coding limitations remain. Documenting the full burden of drowning is vital to ensuring that the issue is fully understood and its prevention adequately resourced. Further research examining the severity of non-fatal drowning cases requiring hospitalisation and tracking outcomes of those discharged will provide a more complete picture.

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Using a retrospective cross-sectional study to analyse unintentional fatal drowning in Australia: ICD-10 coding-based methodologies verses actual deaths

BMJ Open ◽

10.1136/bmjopen-2017-019407 ◽

2017 ◽

Vol 7 (12) ◽

pp. e019407 ◽

Cited By ~ 26

Author(s):

Amy E Peden ◽

Richard C Franklin ◽

Alison J Mahony ◽

Justin Scarr ◽

Paul D Barnsley

Keyword(s):

Causes Of Death ◽

International Classification Of Diseases ◽

Cross Sectional Study ◽

Cross Sectional ◽

Life Saving ◽

Classification Of Diseases ◽

Icd 10 ◽

Underlying Causes ◽

Icd Codes ◽

Underlying Cause Of Death

ObjectivesFatal drowning estimates using a single underlying cause of death (UCoD) may under-represent the number of drowning deaths. This study explores how data vary by International Classification of Diseases (ICD)-10 coding combinations and the use of multiple underlying causes of death using a national register of drowning deaths.DesignAn analysis of ICD-10 external cause codes of unintentional drowning deaths for the period 2007–2011 as extracted from an Australian total population unintentional drowning database developed by Royal Life Saving Society—Australia (the Database). The study analysed results against three reporting methodologies: primary drowning codes (W65-74), drowning-related codes, plus cases where drowning was identified but not the UCoD.SettingAustralia, 2007–2011.ParticipantsUnintentional fatal drowning cases.ResultsThe Database recorded 1428 drowning deaths. 866 (60.6%) had an UCoD of W65-74 (accidental drowning), 249 (17.2%) cases had an UCoD of either T75.1 (0.2%), V90 (5.5%), V92 (3.5%), X38 (2.4%) or Y21 (5.9%) and 53 (3.7%) lacked ICD coding. Children (aged 0–17 years) were closely aligned (73.9%); however, watercraft (29.2%) and non-aquatic transport (13.0%) were not. When the UCoD and all subsequent causes are used, 67.2% of cases include W65-74 codes. 91.6% of all cases had a drowning code (T75.1, V90, V92, W65-74, X38 and Y21) at any level.ConclusionDefining drowning with the codes W65-74 and using only the UCoD captures 61% of all drowning deaths in Australia. This is unevenly distributed with adults, watercraft and non-aquatic transport-related drowning deaths under-represented. Using a wider inclusion of ICD codes, which are drowning-related and multiple causes of death minimises this under-representation. A narrow approach to counting drowning deaths will negatively impact the design of policy, advocacy and programme planning for prevention.

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Validating Coding for the Identification of Pediatric Treatment Resistant Epilepsy Patients

Child Neurology Open ◽

10.1177/2329048x211037806 ◽

2021 ◽

Vol 8 ◽

pp. 2329048X2110378

Author(s):

Daniel A. Freedman ◽

Zachary Grinspan ◽

Peter Glynn ◽

Jackson Mittlesteadt ◽

Alex Dawes ◽

...

Keyword(s):

Refractory Epilepsy ◽

International Classification Of Diseases ◽

Cross Sectional Study ◽

Absence Epilepsy ◽

Treatment Resistant ◽

Cross Sectional ◽

Classification Of Diseases ◽

Icd Codes ◽

Pediatric Treatment

The International Classification of Diseases (ICD) system includes sub codes to indicate that an individual with epilepsy is treatment resistant. These codes would be a valuable tool to identify individuals for quality improvement and population health, as well as for recruitment into clinical trials. However, the accuracy of these codes is unclear. We performed a single center cross sectional study to understand the accuracy of ICD codes for treatment resistant epilepsy. We identified 344 individuals, roughly half with treatment resistant epilepsy The ICD code had a sensitivity of 90% (147 of 164) and specificity of 86% (155 of 180). The miscoding of children with refractory epilepsy was attributed to the following reasons: 5 patients had epilepsy surgery, 4 had absence epilepsy, 4 patients were seen by different providers, and 1 patient was most recently seen in movement disorders clinic. ICD codes accurately identify children with treatment resistant epilepsy.

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ELEVATED UNCONJUGATED BILIRUBIN IN SCHIZOPHRENIC PATIENTS

Nusantara Medical Science Journal ◽

10.20956/nmsj.v3i1.5780 ◽

2018 ◽

Vol 3 (1) ◽

pp. 20

Author(s):

Ilhamuddin Aziz ◽

Yuyun Widaningsih ◽

Rosdiana Natzir ◽

A. Jayalangkara Tanra

Keyword(s):

Total Bilirubin ◽

International Classification Of Diseases ◽

Cross Sectional ◽

Elevated Liver Enzymes ◽

Two Samples ◽

Classification Of Diseases ◽

Icd 10 ◽

Schizophrenic Patients ◽

Schizophrenic Group ◽

Cross Sectional Design

Strategies for schizophrenic treatment still have been developed in order to increase their effectively, based on latest findings in the etio-pathology. Coincidence of hyperbilirubinemia, especially related to Gilbert’s Syndrome (GS), and schizophrenia/other psychiatric disorders, was reported in several studies although the pattern of this alteration is still controversial. Bilirubin could induce microglia to release pro-inflammatory cytokine that cause neuroinflammation, one of hypothetic etio-pathogenesis has been the most extensively studied recently. However, no data have been presented about this phenomenon in Indonesia. Therefore, this study aims to investigate plasma bilirubin concentration in psychotic spectrum.This study is cross sectional design that we examined both the total bilirubin and direct bilirubin of every psychotic patient admitted for the first time to Rumah Sakit Khusus Daerah (RSKD) Provinsi Sulawesi Selatan over a period of July—December 2012, by using health people as control. Diagnostic determination was set based on International Classification of Diseases (ICD) 10. Patients suffering from any disease such as anemia (decreased hemoglobin), liver diseases (elevated liver enzymes), or substance abuse were excluded. From 73 samples, we found that plasma UCB level was significantly elevated, higher in psychotic patients, especially schizophrenic group, than in the control. Total bilirubin rate was slightly increased in schizophrenic group compare to the others and two samples in this group showed hyperbilirubinemia. Further investigations are needed to ensure that whether the elevated UCB was related to GS and whether this condition has inflammatory effect.

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Prevalence of mental disorders in Australia: some evidence from the Hospital Morbidity Collection in New South Wales

Journal of Biosocial Science ◽

10.1017/s0021932000015170 ◽

1984 ◽

Vol 16 (3) ◽

pp. 357-367 ◽

Cited By ~ 2

Author(s):

Farhat Yusuf ◽

M. Hamid Sheikh

Keyword(s):

Mental Disorders ◽

New South ◽

New South Wales ◽

International Classification Of Diseases ◽

Ethnic Origin ◽

Affective Psychosis ◽

South Wales ◽

Classification Of Diseases ◽

Hospital Morbidity

SummaryThis study examines data from 47,238 episodes of hospitalization in New South Wales, Australia, pertaining to the patients suffering from mental disorders, i.e. those patients with a principal diagnosis coded from 290 to 315 inclusive, according to the 8th revision of the International Classification of Diseases.An overall prevalence of nine episodes of hospitalization due to mental disorders was found per 1000 population per annum. Major disease categories were neuroses and alcoholism (each accounting for 21% of the total episodes) followed by schizophrenia (16%) and affective psychosis (11%); there were substantial differences by age, sex, marital status and ethnic origin.

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Vulnerability to fatal drowning among the population in Southern Bangladesh: findings from a cross-sectional household survey

BMJ Open ◽

10.1136/bmjopen-2018-027896 ◽

2019 ◽

Vol 9 (9) ◽

pp. e027896 ◽

Cited By ~ 3

Author(s):

Aminur Rahman ◽

Jagnoor Jagnoor ◽

Kamran ul Baset ◽

Dan Ryan ◽

Tahera Ahmed ◽

...

Keyword(s):

Urban Areas ◽

Public Health Problem ◽

Household Survey ◽

Risk Groups ◽

International Classification Of Diseases ◽

Operational Definition ◽

Cross Sectional ◽

Increased Risk ◽

Classification Of Diseases ◽

Associated Risk Factors

ObjectivesThis study aimed to determine the fatal drowning burden and associated risk factors in Southern Bangladesh.SettingsThe survey was conducted in 39 subdistricts of all 6 districts of the Barisal division, Southern Bangladesh.ParticipantsAll residents (for a minimum 6 months prior to survey) of the Barisal division, Southern Bangladesh.Intervention/methodsA cross-sectional, divisionally representative household survey was conducted in all six districts of the Barisal division between September 2016 and February 2017, covering a population of 386 016. Data were collected by face-to-face interview with adult respondents using handheld electronic tablets. International Classification of Diseases (ICD)-v. 10 (ICD-10) Chapter XX: External causes of morbidity and mortality codes for drowning, W65–W74, X36–X39, V90, V92, X71 or X92, were used as the operational definition of a drowning event.ResultsThe overall fatal drowning rate in Barisal was 37.9/100 000 population per year (95% CI 31.8 to 43.9). The highest fatal drowning rate was observed among children aged 1–4 years (262.2/100 000/year). Mortality rates among males (48.2/100 000/year) exceeded that for females (27.9/100 000/year). A higher rate of fatal drowning was found in rural (38.9/100 000/year) compared with urban areas (29.3/100 000/year). The results of the multivariable logistic regression identified that the factors significantly associated with fatal drowning were being male (OR 1.7, 95% CI 1.2 to 2.3), aged 1–4 years (OR 3.0, 95% CI 1.4 to 6.4) and residing in a household with four or more children (four or more children OR 1.8, 95% CI 1.1 to 2.9; and five or more children OR 2.1, 95% CI 1.2 to 3.7).ConclusionDrowning is a public health problem, especially for children, in the Barisal division of Southern Bangladesh. Male gender, children 1–4 years of age and residing in a household with four or more children were associated with increased risk of fatal drowning events. The Barisal division demands urgent interventions targeted at high-risk groups identified in the survey.

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The distinctive neural circuitry of complex posttraumatic stress disorder during threat processing

Psychological Medicine ◽

10.1017/s0033291719003921 ◽

2020 ◽

pp. 1-8

Author(s):

Richard A. Bryant ◽

Kim L. Felmingham ◽

Gin Malhi ◽

Elpiniki Andrew ◽

Mayuresh S. Korgaonkar

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

International Classification Of Diseases ◽

Complex Posttraumatic Stress Disorder ◽

Cross Sectional ◽

Amygdala Activation ◽

Threat Processing ◽

Dorsolateral Prefrontal ◽

Classification Of Diseases

Abstract Background There is controversy over the extent to which the new International Classification of Diseases (ICD-11) diagnosis of complex posttraumatic stress disorder (CPTSD) is distinct from posttraumatic stress disorder (PTSD). This study aimed to conduct the first investigation of distinctive neural processes during threat processing in CPTSD relative to PTSD. Method This cross-sectional functional magnetic resonance study included 99 participants who met criteria for PTSD (PTSD = 32, CPTSD = 28) and 39 trauma-exposed controls. PTSD was assessed with the Clinician-Administered PTSD Scale (CAPS). CPTSD was assessed with an adapted version of the International Trauma Questionnaire. Neural responses were measured across the brain while threat or neutral faces were presented at both supraliminal and subliminal levels. Results During supraliminal presentations of threat stimuli, there was greater bilateral insula and right amygdala activation in CPTSD participants relative to PTSD. Reduced supraliminal right dorsolateral prefrontal cortex activation and increased subliminal amygdala and insula activation were observed as common dysfunction for both CPTSD and PTSD groups relative to trauma controls. There were no significant differences in terms of subliminal presentations and no differences in functional connectivity. Dissociative responses were positively associated with right insula activation (r = 0.347, p < 0.01). Conclusions These results provide the first evidence of distinct neural profiles of CPTSD and PTSD during threat processing. The observation of increased insula and right amygdala activation in CPTSD accords with the proposal that CPTSD is distinguished from PTSD by disturbances in emotion regulation and self-concept.

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Impact of ICD10 and secular changes on electronic medical record rheumatoid arthritis algorithms

Rheumatology ◽

10.1093/rheumatology/keaa198 ◽

2020 ◽

Vol 59 (12) ◽

pp. 3759-3766 ◽

Cited By ~ 1

Author(s):

Sicong Huang ◽

Jie Huang ◽

Tianrun Cai ◽

Kumar P Dahal ◽

Andrew Cagan ◽

...

Keyword(s):

Language Processing ◽

Gold Standard ◽

International Classification Of Diseases ◽

Data Mart ◽

Classification Of Diseases ◽

Icd Codes ◽

Rule Based Approach ◽

Citrullinated Peptide ◽

Better Than

Abstract Objective The objective of this study was to compare the performance of an RA algorithm developed and trained in 2010 utilizing natural language processing and machine learning, using updated data containing ICD10, new RA treatments, and a new electronic medical records (EMR) system. Methods We extracted data from subjects with ≥1 RA International Classification of Diseases (ICD) codes from the EMR of two large academic centres to create a data mart. Gold standard RA cases were identified from reviewing a random 200 subjects from the data mart, and a random 100 subjects who only have RA ICD10 codes. We compared the performance of the following algorithms using the original 2010 data with updated data: (i) a published 2010 RA algorithm; (ii) updated algorithm, incorporating ICD10 RA codes and new DMARDs; and (iii) published algorithm using ICD codes only, ICD RA code ≥3. Results The gold standard RA cases had mean age 65.5 years, 78.7% female, 74.1% RF or antibodies to cyclic citrullinated peptide (anti-CCP) positive. The positive predictive value (PPV) for ≥3 RA ICD was 54%, compared with 56% in 2010. At a specificity of 95%, the PPV of the 2010 algorithm and the updated version were both 91%, compared with 94% (95% CI: 91, 96%) in 2010. In subjects with ICD10 data only, the PPV for the updated 2010 RA algorithm was 93%. Conclusion The 2010 RA algorithm validated with the updated data with similar performance characteristics as the 2010 data. While the 2010 algorithm continued to perform better than the rule-based approach, the PPV of the latter also remained stable over time.

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Comparative analysis of methods for identifying multimorbidity patterns: a study of ‘real-world’ data

BMJ Open ◽

10.1136/bmjopen-2017-018986 ◽

2018 ◽

Vol 8 (3) ◽

pp. e018986 ◽

Cited By ~ 12

Author(s):

Albert Roso-Llorach ◽

Concepción Violán ◽

Quintí Foguet-Boreu ◽

Teresa Rodriguez-Blanco ◽

Mariona Pons-Vigués ◽

...

Keyword(s):

Real World ◽

Hierarchical Cluster ◽

International Classification Of Diseases ◽

Cross Sectional Study ◽

Real World Data ◽

Cross Sectional ◽

World Data ◽

Data Usage ◽

Classification Of Diseases ◽

Depth Study

ObjectiveThe aim was to compare multimorbidity patterns identified with the two most commonly used methods: hierarchical cluster analysis (HCA) and exploratory factor analysis (EFA) in a large primary care database. Specific objectives were: (1) to determine whether choice of method affects the composition of these patterns and (2) to consider the potential application of each method in the clinical setting.DesignCross-sectional study. Diagnoses were based on the 263 corresponding blocks of the International Classification of Diseases version 10. Multimorbidity patterns were identified using HCA and EFA. Analysis was stratified by sex, and results compared for each method.Setting and participantsElectronic health records for 408 994 patients with multimorbidity aged 45–64 years in 274 primary health care teams from 2010 in Catalonia, Spain.ResultsHCA identified 53 clusters for women, with just 12 clusters including at least 2 diagnoses, and 15 clusters for men, all of them including at least two diagnoses. EFA showed 9 factors for women and 10 factors for men. We observed differences by sex and method of analysis, although some patterns were consistent. Three combinations of diseases were observed consistently across sex groups and across both methods: hypertension and obesity, spondylopathies and deforming dorsopathies, and dermatitis eczema and mycosis.ConclusionsThis study showed that multimorbidity patterns vary depending on the method of analysis used (HCA vs EFA) and provided new evidence about the known limitations of attempts to compare multimorbidity patterns in real-world data studies. We found that EFA was useful in describing comorbidity relationships and HCA could be useful for in-depth study of multimorbidity. Our results suggest possible applications for each of these methods in clinical and research settings, and add information about some aspects that must be considered in standardisation of future studies: spectrum of diseases, data usage and methods of analysis.

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Validation of intellectual disability coding through hospital morbidity records using an intellectual disability population-based database in Western Australia

BMJ Open ◽

10.1136/bmjopen-2017-019113 ◽

2018 ◽

Vol 8 (1) ◽

pp. e019113 ◽

Cited By ~ 6

Author(s):

Jenny Bourke ◽

Kingsley Wong ◽

Helen Leonard

Keyword(s):

Intellectual Disability ◽

International Classification Of Diseases ◽

Population Based ◽

Reliable Source ◽

Morbidity Data ◽

Classification Of Diseases ◽

Data Source ◽

Hospital Morbidity ◽

Western Australian ◽

Hospital Morbidity Data

ObjectivesTo investigate how well intellectual disability (ID) can be ascertained using hospital morbidity data compared with a population-based data source.Design, setting and participantsAll children born in 1983–2010 with a hospital admission in the Western Australian Hospital Morbidity Data System (HMDS) were linked with the Western Australian Intellectual Disability Exploring Answers (IDEA) database. The International Classification of Diseases hospital codes consistent with ID were also identified.Main outcome measuresThe characteristics of those children identified with ID through either or both sources were investigated.ResultsOf the 488 905 individuals in the study, 10 218 (2.1%) were identified with ID in either IDEA or HMDS with 1435 (14.0%) individuals identified in both databases, 8305 (81.3%) unique to the IDEA database and 478 (4.7%) unique to the HMDS dataset only. Of those unique to the HMDS dataset, about a quarter (n=124) had died before 1 year of age and most of these (75%) before 1 month. Children with ID who were also coded as such in the HMDS data were more likely to be aged under 1 year, female, non-Aboriginal and have a severe level of ID, compared with those not coded in the HMDS data. The sensitivity of using HMDS to identify ID was 14.7%, whereas the specificity was much higher at 99.9%.ConclusionHospital morbidity data are not a reliable source for identifying ID within a population, and epidemiological researchers need to take these findings into account in their study design.

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Increasing Sepsis Rates in the United States: Results From National Inpatient Sample, 2005 to 2014

Journal of Intensive Care Medicine ◽

10.1177/0885066618794136 ◽

2018 ◽

Vol 35 (9) ◽

pp. 858-868 ◽

Cited By ~ 8

Author(s):

Muni Rubens ◽

Anshul Saxena ◽

Venkataraghavan Ramamoorthy ◽

Sankalp Das ◽

Rohan Khera ◽

...

Keyword(s):

International Classification Of Diseases ◽

The United States ◽

Relative Increase ◽

National Inpatient Sample ◽

Readmission Rates ◽

Cross Sectional ◽

Hospitalization Cost ◽

Classification Of Diseases ◽

Coding Rules ◽

Age And Sex

Objectives:To examine the trends in hospitalization rates, mortality, and costs for sepsis during the years 2005 to 2014.Methods:This was a retrospective serial cross-sectional analysis of patients ≥18 years admitted for sepsis in National Inpatient Sample. Trends in sepsis hospitalizations were estimated, and age- and sex-adjusted rates were calculated for the years 2005 to 2014.Results:There were 541 694 sepsis admissions in 2005 and increased to 1 338 905 in 2014. Sepsis rates increased significantly from 1.2% to 2.7% during the years 2005 to 2014 (relative increase: 123.8%; Ptrend< .001). However, the relative increase changed by 105.8% ( Ptrend< .001) after adjusting for age and sex and maintained significance. Although total cost of hospitalization due to sepsis increased significantly from US$22.2 to US$38.1 billion ( Ptrend< .001), the mean hospitalization cost decreased significantly from US$46,470 to US$29,290 ( Ptrend< .001).Conclusions:Hospitalizations for sepsis increased during the years 2005 to 2014. Our study paradoxically found declining rates of in-hospital mortality, length of stay, and mean hospitalization cost for sepsis. These findings could be due to biases introduced by International Classification of Diseases, Ninth Revision, Clinical Modification coding rules and increased readmission rates or alternatively due to increased awareness and surveillance and changing disposition status. Standardized epidemiologic registries should be developed to overcome these biases.

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