TY - JOUR
T1 - Validation of ICD-9-CM codes for identification of acetaminophen-related emergency department visits in a large pediatric hospital
AU - De Achaval, Sofia
AU - Feudtner, Chris
AU - Palla, Shana
AU - Suarez-Almazor, Maria E.
N1 - Funding Information:
This project was supported by cooperative agreement number No. 1U18 HSO017991-01 from the Agency for Healthcare Research and Quality (AHRQ) using funding from the US Food and Drug Administration (FDA) though Interagency Agreement No. 224-08-3591. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ, FDA, or the US Department of Health and Human Services.
PY - 2013
Y1 - 2013
N2 - Background: Acetaminophen overdose is a major concern among the pediatric population. Our objective was to assess the validity of International Classification of Disease (ICD-9-CM) codes for identification of pediatric emergency department (ED) visits resulting from acetaminophen exposure or overdose. Methods. We conducted a retrospective medical record review of ED visits at Texas Children's Hospital in Houston, Texas, between January 1, 2005, and December 31, 2010. Visits coded with 1 or more ICD-9 codes for poisoning (965, 977, and their subcodes and supplemental E-codes E850, E858, E935, E947, and E950 and their subcodes) were identified from an administrative database, and further review of the medical records was conducted to identify true cases of acetaminophen exposure or overdose. We then examined the sensitivity, positive predictive value, and percentage of false positives identified by various codes and code combinations to establish which codes most accurately identified acetaminophen exposure or overdose. Results: Of 1,215 ED visits documented with 1 or more of the selected codes, 316 (26.0%) were a result of acetaminophen exposure or overdose. Sensitivity was highest (87.0%) for the combination of codes 965.4 (poisoning by aromatic analgesics, not elsewhere classified) and E950.0 (suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics), with a positive predictive value of 86.2%. Code 965.4 alone yielded a sensitivity of 85.1%, with a positive predictive value of 92.8%. Code performance varied among age groups and depending on the type of exposure (intentional or unintentional). Conclusion: ICD-9 codes are useful for ascertaining which ED visits are a result of acetaminophen exposure or overdose within the pediatric population. However, because ICD-9 coding differs by age group and depending on the type of exposure, hypothesis-driven strategies must be utilized for each pediatric age group to avoid misclassification.
AB - Background: Acetaminophen overdose is a major concern among the pediatric population. Our objective was to assess the validity of International Classification of Disease (ICD-9-CM) codes for identification of pediatric emergency department (ED) visits resulting from acetaminophen exposure or overdose. Methods. We conducted a retrospective medical record review of ED visits at Texas Children's Hospital in Houston, Texas, between January 1, 2005, and December 31, 2010. Visits coded with 1 or more ICD-9 codes for poisoning (965, 977, and their subcodes and supplemental E-codes E850, E858, E935, E947, and E950 and their subcodes) were identified from an administrative database, and further review of the medical records was conducted to identify true cases of acetaminophen exposure or overdose. We then examined the sensitivity, positive predictive value, and percentage of false positives identified by various codes and code combinations to establish which codes most accurately identified acetaminophen exposure or overdose. Results: Of 1,215 ED visits documented with 1 or more of the selected codes, 316 (26.0%) were a result of acetaminophen exposure or overdose. Sensitivity was highest (87.0%) for the combination of codes 965.4 (poisoning by aromatic analgesics, not elsewhere classified) and E950.0 (suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics), with a positive predictive value of 86.2%. Code 965.4 alone yielded a sensitivity of 85.1%, with a positive predictive value of 92.8%. Code performance varied among age groups and depending on the type of exposure (intentional or unintentional). Conclusion: ICD-9 codes are useful for ascertaining which ED visits are a result of acetaminophen exposure or overdose within the pediatric population. However, because ICD-9 coding differs by age group and depending on the type of exposure, hypothesis-driven strategies must be utilized for each pediatric age group to avoid misclassification.
KW - Acetaminophen
KW - Emergency department
KW - Overdose
KW - Pediatric
KW - Validity
UR - http://www.scopus.com/inward/record.url?scp=84874006623&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84874006623&partnerID=8YFLogxK
U2 - 10.1186/1472-6963-13-72
DO - 10.1186/1472-6963-13-72
M3 - Article
C2 - 23433397
AN - SCOPUS:84874006623
SN - 1472-6963
VL - 13
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - 1
M1 - 72
ER -