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- Title
Accuracy of Influenza ICD-10 Diagnosis Codes in Identifying Influenza Illness in Children.
- Authors
Antoon, James W.; Stopczynski, Tess; Amarin, Justin Z.; Stewart, Laura S.; Boom, Julie A.; Sahni, Leila C.; Michaels, Marian G.; Williams, John V.; Englund, Janet A.; Klein, Eileen J.; Staat, Mary A.; Schlaudecker, Elizabeth P.; Selvarangan, Rangaraj; Schuster, Jennifer E.; Weinberg, Geoffrey A.; Szilagyi, Peter G.; Perez, Ariana; Moline, Heidi L.; Spieker, Andrew J.; Grijalva, Carlos G.
- Abstract
Key Points: Question: How accurate are International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) discharge diagnosis codes in identifying pediatric influenza illness? Findings: In this cohort study of 32 968 children seeking care for fever and/or respiratory symptoms in the emergency department (ED) and inpatient settings, ICD-10 influenza discharge diagnosis codes were highly specific, with high positive predictive value and negative predictive value but modest sensitivity compared with laboratory-confirmed influenza. When stratified by age, specificity was lowest among infants. Meaning: These findings suggest that ICD-10 influenza diagnoses likely represent true-positive influenza cases in the ED and inpatient settings, but their sensitivity in identifying cases of influenza illness is modest. This cohort study examines the accuracy of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) influenza discharge diagnosis codes in the pediatric emergency department and inpatient settings. Importance: Studies of influenza in children commonly rely on coded diagnoses, yet the ability of International Classification of Diseases, Ninth Revision codes to identify influenza in the emergency department (ED) and hospital is highly variable. The accuracy of newer International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes to identify influenza in children is unknown. Objective: To determine the accuracy of ICD-10 influenza discharge diagnosis codes in the pediatric ED and inpatient settings. Design, Setting, and Participants: Children younger than 18 years presenting to the ED or inpatient settings with fever and/or respiratory symptoms at 7 US pediatric medical centers affiliated with the Centers for Disease Control and Prevention–sponsored New Vaccine Surveillance Network from December 1, 2016, to March 31, 2020, were included in this cohort study. Nasal and/or throat swabs were collected for research molecular testing for influenza, regardless of clinical testing. Data, including ICD-10 discharge diagnoses and clinical testing for influenza, were obtained through medical record review. Data analysis was performed in August 2023. Main Outcomes and Measures: The accuracy of ICD-10–coded discharge diagnoses was characterized using molecular clinical or research laboratory test results as reference. Measures included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Estimates were stratified by setting (ED vs inpatient) and age (0-1, 2-4, and 5-17 years). Results: A total of 16 867 children in the ED (median [IQR] age, 2.0 [0.0-4.0] years; 9304 boys [55.2%]) and 17 060 inpatients (median [IQR] age, 1.0 [0.0-4.0] years; 9798 boys [57.4%]) were included. In the ED, ICD-10 influenza diagnoses were highly specific (98.0%; 95% CI, 97.8%-98.3%), with high PPV (88.6%; 95% CI, 88.0%-89.2%) and high NPV (85.9%; 95% CI, 85.3%-86.6%), but sensitivity was lower (48.6%; 95% CI, 47.6%-49.5%). Among inpatients, specificity was 98.2% (95% CI, 98.0%-98.5%), PPV was 82.8% (95% CI, 82.1%-83.5%), sensitivity was 70.7% (95% CI, 69.8%-71.5%), and NPV was 96.5% (95% CI, 96.2%-96.9%). Accuracy of ICD-10 diagnoses varied by patient age, influenza season definition, time between disease onset and testing, and clinical setting. Conclusions and Relevance: In this large cohort study, influenza ICD-10 discharge diagnoses were highly specific but moderately sensitive in identifying laboratory-confirmed influenza; the accuracy of influenza diagnoses varied by clinical and epidemiological factors. In the ED and inpatient settings, an ICD-10 diagnosis likely represents a true-positive influenza case.
- Subjects
UNITED States; INFLUENZA diagnosis; PREDICTIVE tests; PUBLIC health surveillance; DIFFERENTIAL diagnosis; RESEARCH funding; RESEARCH evaluation; POLYMERASE chain reaction; HOSPITAL emergency services; DISCHARGE planning; CHILDREN'S hospitals; DESCRIPTIVE statistics; LONGITUDINAL method; RACE; MEDICAL coding; MEDICAL records; ACQUISITION of data; COMPUTER-aided diagnosis; CENTERS for Disease Control &; Prevention (U.S.); CONFIDENCE intervals; DATA analysis software; NOSOLOGY; SENSITIVITY &; specificity (Statistics); EVALUATION; CHILDREN
- Publication
JAMA Network Open, 2024, Vol 7, Issue 1, pe248255
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.8255