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A new diagnosis grouping system for child emergency department visits
Evaline A Alessandrini1, Elizabeth R Alpern, James M Chamberlain
1Department of Pediatrics, University of Pennsylvania School of Medicine and Emergency Medicine, The Children's Hospital of Philadelphia, PA, USA. evaline.alessandrini@cchmc.org
Insights
A new diagnosis grouping system (DGS) for pediatric emergency visits was developed using ICD-9 codes. This clinically sensible and comprehensive system aids research and reporting for child emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Health Informatics
- Disease Classification Systems
Background:
- A need exists for a clinically sensible system to group pediatric emergency diagnoses for research and reporting.
- Existing systems may not adequately capture the nuances of child emergency department (ED) visits.
Purpose of the Study:
- To create an International Classification of Diseases (ICD)-based diagnosis grouping system (DGS) for pediatric ED visits.
- To ensure the DGS is clinically sensible and accounts for over 95% of diagnoses.
- To assess the DGS's construct validity by examining diagnosis frequency variations.
Main Methods:
- A panel of emergency physicians utilized the nominal group technique and Delphi surveys.
- The Pediatric Emergency Care Applied Research Network (PECARN) Core Data Project (PCDP) was the primary data source.
- 3,041 ICD-9 codes from the PCDP formed the basis for the DGS.
Main Results:
- The developed DGS includes 21 major groups and 77 subgroups.
- The DGS accounts for 96.5% to 99% of diagnoses across multiple datasets.
- Variations in diagnosis frequency by season, age, sex, and hospital type confirmed construct validity.
Conclusions:
- The DGS provides a clinically sensible, consensus-derived method for describing pediatric ED visits.
- This classification scheme can be utilized for research, reporting, needs assessment, and resource planning.
Objectives:
A clinically sensible system of grouping diseases is needed for describing pediatric emergency diagnoses for research and reporting. This project aimed to create an International Classification of Diseases (ICD)-based diagnosis grouping system (DGS) for child emergency department (ED) visits that is 1) clinically sensible with regard to how diagnoses are grouped and 2) comprehensive in accounting for nearly all diagnoses (>95%). The second objective was to assess the construct validity of the DGS by examining variation in the frequency of targeted groups of diagnoses within the concepts of season, age, sex, and hospital type.
Methods:
A panel of general and pediatric emergency physicians used the nominal group technique and Delphi surveys to create the DGS. The primary data source used to develop the DGS was the Pediatric Emergency Care Applied Research Network (PECARN) Core Data Project (PCDP).
Results:
A total of 3,041 ICD-9 codes, accounting for 98.9% of all diagnoses in the PCDP, served as the basis for creation of the DGS. The expert panel developed a DGS framework representing a clinical approach to the diagnosis and treatment of pediatric emergency patients. The resulting DGS has 21 major groups and 77 subgroups and accounts for 96.5% to 99% of diagnoses when applied to three external data sets. Variations in the frequency of targeted groups of diagnoses related to seasonality, age, sex, and site of care confirm construct validity.
Conclusions:
The DGS offers a clinically sensible method for describing pediatric ED visits by grouping ICD-9 codes in a consensus-derived classification scheme. This system may be used for research, reporting, needs assessment, and resource planning.
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