United States emergency department visits for children with cerebrospinal fluid shunts

2021 ◽  
Vol 27 (1) ◽  
pp. 23-29
Author(s):  
Amrita Hari-Raj ◽  
Lauren Q. Malthaner ◽  
Junxin Shi ◽  
Jeffrey R. Leonard ◽  
Julie C. Leonard
Keyword(s):  
United States ◽  
Emergency Department ◽  
Diagnostic Imaging ◽  
Surgical Intervention ◽  
International Classification Of Diseases ◽  
Shunt Malfunction ◽  
Shunt Placement ◽  
Classification Of Diseases ◽  
Ed Visits

OBJECTIVECSF shunt placement is the primary therapy for hydrocephalus; however, shunt malfunctions remain common and lead to neurological deficits if missed. There is a lack of literature characterizing the epidemiology of children with possible shunt malfunctions presenting to United States emergency departments (EDs).METHODSA retrospective study was conducted of the 2006–2017 National Emergency Department Sample. The data were queried using an exhaustive list of Current Procedural Terminology and International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes representing children with hydrocephalus diagnoses, diagnostic imaging for shunt malfunctions, and shunt-related surgical revision procedures.RESULTSIn 2017, there were an estimated 16,376 ED visits for suspected shunt malfunction. Children were more commonly male (57.9%), ages 0–4 years (42.2%), and publicly insured (55.8%). Many did not undergo diagnostic imaging (37.2%), and of those who did, most underwent head CT scans (43.7%). Between 2006 and 2017, pediatric ED visits for suspected shunt malfunction increased 18% (95% CI 12.1–23.8). The use of MRI increased substantially (178.0%, 95% CI 176.9–179.2). Visits resulting in discharge home from the ED increased by 76.3% (95% CI 73.1–79.4), and those involving no surgical intervention increased by 32.9% (95% CI 29.2–36.6).CONCLUSIONSBetween 2006 and 2017, ED visits for children to rule out shunt malfunction increased, yet there was a decline in surgical intervention and an increase in discharges home from the ED. Possible contributing factors include improved clinical criteria for shunt evaluation, alternative CSF diversion techniques, changing indications for shunt placement, and increased use of advanced imaging in the ED.

scholarly journals Identification of work-related injury emergency department visits using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes

2021 ◽  
Vol 27 (Suppl 1) ◽  
pp. i3-i8
Author(s):  
Ashley M Bush ◽  
Terry L Bunn ◽  
Madison Liford
Keyword(s):  
Emergency Department ◽  
International Classification Of Diseases ◽  
Injury Surveillance ◽  
Discharge Data ◽  
Work Related ◽  
Work Related Injury ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Ed Visits

IntroductionEmergency department (ED) visit discharge data are a less explored population-based data source used to identify work-related injuries. When using discharge data, work-relatedness is often determined by the expected payer of workers’ compensation (WC). In October 2015, healthcare discharge data coding systems transitioned to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). ICD-10-CM’s structure offers potential new work-related codes to enhance work-related injury surveillance. This study identified work-related ED visits using relevant ICD-10-CM work-related injury codes. Cases identified using this method were compared with those identified using the WC expected payer approach.MethodsState ED visit discharge data (2016–2019) were analysed using the CDC’s discharge data surveillance definition. Injuries were identified using a diagnosis code or an external cause-of-injury code in any field. Injuries were assessed by mechanism and expected payer. Literature searches and manual review of ICD-10-CM codes were conducted to identify possible work-related injury codes. Descriptive statistics were performed and assessed by expected payer.ResultsWC was billed for 87 361 injury ED visits from 2016 to 2019. Falls were the most frequent injury mechanism. The 246 ICD-10-CM work-related codes identified 36% more work-related ED injury visits than using WC as the expected payer alone.ConclusionThis study identified potential ICD-10-CM codes to expand occupational injury surveillance using discharge data beyond the traditional WC expected payer approach. Further studies are needed to validate the work-related injury codes and support the development of a work-related injury surveillance case definition.

scholarly journals ICD-10-CM–Based Definitions for Emergency Department Opioid Poisoning Surveillance: Electronic Health Record Case Confirmation Study

2020 ◽  
Vol 135 (2) ◽  
pp. 262-269
Author(s):  
Svetla Slavova ◽  
Dana Quesinberry ◽  
Julia F. Costich ◽  
Emilia Pasalic ◽  
Pedro Martinez ◽  
...  
Keyword(s):  
Emergency Department ◽  
Drug Testing ◽  
International Classification Of Diseases ◽  
Case Definitions ◽  
Health Care Networks ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Ed Visits ◽  
Representative Samples

Objectives: Valid opioid poisoning morbidity definitions are essential to the accuracy of national surveillance. The goal of our study was to estimate the positive predictive value (PPV) of case definitions identifying emergency department (ED) visits for heroin or other opioid poisonings, using billing records with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Methods: We examined billing records for ED visits from 4 health care networks (12 EDs) from October 2015 through December 2016. We conducted medical record reviews of representative samples to estimate the PPVs and 95% confidence intervals (CIs) of (1) first-listed heroin poisoning diagnoses (n = 398), (2) secondary heroin poisoning diagnoses (n = 102), (3) first-listed other opioid poisoning diagnoses (n = 452), and (4) secondary other opioid poisoning diagnoses (n = 103). Results: First-listed heroin poisoning diagnoses had an estimated PPV of 93.2% (95% CI, 90.0%-96.3%), higher than secondary heroin poisoning diagnoses (76.5%; 95% CI, 68.1%-84.8%). Among other opioid poisoning diagnoses, the estimated PPV was 79.4% (95% CI, 75.7%-83.1%) for first-listed diagnoses and 67.0% (95% CI, 57.8%-76.2%) for secondary diagnoses. Naloxone was administered in 867 of 1055 (82.2%) cases; 254 patients received multiple doses. One-third of all patients had a previous drug poisoning. Drug testing was ordered in only 354 cases. Conclusions: The study findings suggest that heroin or other opioid poisoning surveillance definitions that include multiple diagnoses (first-listed and secondary) would identify a high percentage of true-positive cases.

scholarly journals Validation of ICD-10-CM codes for injuries complicating pregnancy, childbirth and the puerperium: a medical record review

2021 ◽  
Vol 27 (Suppl 1) ◽  
pp. i9-i12
Author(s):  
Anna Hansen ◽  
Dana Quesinberry ◽  
Peter Akpunonu ◽  
Julia Martin ◽  
Svetla Slavova
Keyword(s):  
Emergency Department ◽  
Medical Record ◽  
International Classification Of Diseases ◽  
Medical Record Review ◽  
Full Sample ◽  
Emergency Department Data ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Record Review

IntroductionThe purpose of this study was to estimate the positive predictive value (PPV) of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for injury, poisoning, physical or sexual assault complicating pregnancy, childbirth and the puerperium (PCP) to capture injury encounters within both hospital and emergency department claims data.MethodsA medical record review was conducted on a sample (n=157) of inpatient and emergency department claims from one Kentucky healthcare system from 2015 to 2017, with any diagnosis in the ICD-10-CM range O9A.2-O9A.4. Study clinicians reviewed medical records for the sampled cases and used an abstraction form to collect information on documented presence of injury and PCP complications. The study estimated the PPVs and the 95% CIs of O9A.2-O9A.4 codes for (1) capturing injuries and (2) capturing injuries complicating PCP.ResultsThe estimated PPV for the codes O9A.2-O9A.4 to identify injury in the full sample was 79.6% (95% CI 73.3% to 85.9%) and the PPV for capturing injuries complicating PCP was 72.0% (95% CI 65.0% to 79.0%). The estimated PPV for an inpatient principal diagnosis O9A.2-O9A.4 to capture injuries was 90.7% (95% CI 82.0% to 99.4%) and the PPV for capturing injuries complicating PCP was 88.4% (95% CI 78.4% to 98.4%). The estimated PPV for any mention of O9A.2-O9A.4 in emergency department data to capture injuries was 95.2% (95% CI 90.6% to 99.9%) and the PPV for capturing injuries complicating PCP was 81.0% (95% CI 72.4% to 89.5%).DiscussionThe O9A.2-O9A.4 codes captured high percentage true injury cases among pregnant and puerperal women.

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.

scholarly journals Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Marc D. Lipman ◽  
Samuel Evan Carstensen ◽  
Dylan Nicole Deal
Keyword(s):  
United States ◽  
Treatment Options ◽  
International Classification Of Diseases ◽  
The United States ◽  
Classification Of Diseases ◽  
And Gender ◽  
Needle Aponeurotomy ◽  
Gender Change ◽  
Dupuytren Disease

Background: Dupuytren disease is a common fibroproliferative disorder. Multiple procedural treatment options are available, with Collagenase Clostridium Histolyticum (CCH) injection being introduced in 2010. The purpose of this study was to investigate trends in the treatment of Dupuytren disease in the United States between 2007 and 2014. Methods: The PearlDiver Humana database was queried using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes for patients with Dupuytren disease that received percutaneous needle aponeurotomy (PNA), fasciotomy, fasciectomy, and CCH injection. Patients were filtered by age, number of comorbidities, and gender. Change in composition of treatments over time was analyzed for each demographic group between 2007 and 2014. Results: Patients presenting to clinic for Dupuytren disease increased from 1118 to 3280, with unchanging treatment percentage of 41. Percent fasciotomies and fasciectomies decreased from 5% to 3% and 33% to 21%, while CCH injection increased to 11% by 2012 to 2014. Percent fasciotomies decreased ( P < .05) in younger healthier (age <65, 0-1 comorbidities) and older less healthy (age 65-74, 4+ comorbidities) populations. Percent fasciectomies decreased significantly in nearly all age and comorbidity groups, but by greater amounts in patients with 2+ comorbidities with increasing age. Percent CCH injections increased in all groups, at rates similar to the losses seen in open procedures. Conclusions: CCH injections have risen to substantial levels, with corresponding decreases in the percentage of patients receiving fasciotomies and fasciectomies. Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity.

scholarly journals Efficiency of International Classification of Diseases, Ninth Revision, Billing Code Searches to Identify Emergency Department Visits for Blood or Body Fluid Exposures through a Statewide Multicenter Database

2012 ◽  
Vol 33 (6) ◽  
pp. 581-588 ◽  
Author(s):  
Lisa M. Rosen ◽  
Tao Liu ◽  
Roland C. Merchant
Keyword(s):  
Body Fluid ◽  
Recursive Partitioning ◽  
International Classification Of Diseases ◽  
Emergency Department Visits ◽  
International Classification ◽  
Misclassification Rate ◽  
Classification Of Diseases ◽  
Ed Visits ◽  
Code Searches

Background.Blood and body fluid exposures are frequently evaluated in emergency departments (EDs). However, efficient and effective methods for estimating their incidence are not yet established.Objective.Evaluate the efficiency and accuracy of estimating statewide ED visits for blood or body fluid exposures using International Classification of Diseases, Ninth Revision (ICD-9), code searches.Design.Secondary analysis of a database of ED visits for blood or body fluid exposure.Setting.EDs of 11 civilian hospitals throughout Rhode Island from January 1, 1995, through June 30, 2001.Patients.Patients presenting to the ED for possible blood or body fluid exposure were included, as determined by prespecified ICD-9 codes.Methods.Positive predictive values (PPVs) were estimated to determine the ability of 10 ICD-9 codes to distinguish ED visits for blood or body fluid exposure from ED visits that were not for blood or body fluid exposure. Recursive partitioning was used to identify an optimal subset of ICD-9 codes for this purpose. Random-effects logistic regression modeling was used to examine variations in ICD-9 coding practices and styles across hospitals. Cluster analysis was used to assess whether the choice of ICD-9 codes was similar across hospitals.Results.The PPV for the original 10 ICD-9 codes was 74.4% (95% confidence interval [CI], 73.2%–75.7%), whereas the recursive partitioning analysis identified a subset of 5 ICD-9 codes with a PPV of 89.9% (95% CI, 88.9%–90.8%) and a misclassification rate of 10.1%. The ability, efficiency, and use of the ICD-9 codes to distinguish types of ED visits varied across hospitals.Conclusions.Although an accurate subset of ICD-9 codes could be identified, variations across hospitals related to hospital coding style, efficiency, and accuracy greatly affected estimates of the number of ED visits for blood or body fluid exposure.

scholarly journals Quantifying Emergency Department Visits From Sport and Recreation: Focus on the Lower Extremity and Knee, 1997–2009

2016 ◽  
Vol 51 (4) ◽  
pp. 309-316 ◽  
Author(s):  
Matthew S. Tenan
Keyword(s):  
Emergency Department ◽  
Lower Extremity ◽  
Population Level ◽  
International Classification Of Diseases ◽  
Emergency Department Visits ◽  
Sample Survey ◽  
Ed Visits ◽  
Nationally Representative ◽  
Sport And Recreation

Few authors have reported nationally representative data on the number of sport and recreation (SR) injuries resulting in emergency department (ED) visitation. The existing studies have only provided 1 or 2 years of data and are not longitudinal in nature.Context: To use a novel algorithmic approach to determine if ED visitation is due to SR, resulting in a substantially larger longitudinal dataset.Objective: Descriptive epidemiology study.Design: Hospital.Setting: The National Hospital Ambulatory Medical Care Survey, a stratified random-sample survey of US hospital EDs was combined for years 1997–2009. There were 15 699 unweighted patient visits determined to be from SR.Patients or Other Participants: A custom algorithm classified SR visits based on the International Classification of Diseases, Ninth Revision, Clinical Modification E-code and pattern recognition of narrative text. Sport and recreation visits were assessed by age and categorized according to broad injury classifications. Additional quantification was performed on SR visits for lower extremity and knee-specific injuries. Sample weights were applied to provide national annual estimates.Main Outcome Measure(s): Annually, 4 243 000 ED visits resulted from SR. The largest classification of injury from SR was sprains and strains (896 000/y). Males had substantially more SR-related ED visits than females (2 929 000/y versus 1 314 000/y). For patients 10–49 years old, 1 093 000 lower extremity and 169 000 knee-specific injury visits annually were from SR. For both injury types, males had a higher rate of ED visitation; however, females had 25% and 39% greater odds of visitation for lower extremity and knee-specific injury, respectively.Results: The burden on the health system of ED visits from SR was substantial. Males presented in the ED at a higher rate for SR injury, though females had a higher proportion of lower extremity and knee-specific injury ED visitations from SR. This longitudinal analysis of population-level data provides the information to target research on specific subpopulations to mitigate SR injury.Conclusions:

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