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Validation of the new diagnosis grouping system for pediatric emergency department visits using the International
Jin Hee Lee1, Ki Jeong Hong, Do Kyun Kim
1From the *Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi; †Department of Emergency Medicine, Seoul National University Boramae Medical Center; ‡Department of Emergency Medicine, Seoul National University College of Medicine; §Department of Emergency Medicine, Soonchunhyang University Seoul Hospital, Seoul; ∥Department of Emergency Medicine, Kwandong University College of Medicine and Myongji Hospital, Gyeonggi; ¶Incheonsarang Hospital, Incheon; and #Sejong General Hospital, Seoul, Republic of Korea.
Insights
A modified Diagnosis Grouping System (DGS) was developed for South Korea, improving pediatric emergency care data. This system accurately captures pediatric emergent conditions, aiding research and policy.
Area of Science:
- Pediatric Emergency Medicine
- Health Informatics
- Public Health Policy
Background:
- A standardized Diagnosis Grouping System (DGS) is crucial for pediatric emergency care research, resource allocation, and national policy.
- The existing Pediatric Emergency Care Applied Research Network (PECARN) DGS requires adaptation for different pediatric populations.
Purpose of the Study:
- To develop a modified PECARN DGS tailored to the unique pediatric population of South Korea.
- To validate this modified DGS for accurate and comparable epidemiologic data collection on pediatric emergent conditions.
Main Methods:
- Utilized the National Emergency Department Information System (South Korea) data, coded with ICD-10.
- Mapped ICD-10 codes to the PECARN DGS using General Equivalence Mappings (GEMs) and ICD-9 conversion.
- Employed a two-round electronic Delphi survey and expert consensus for unmatched diagnosis codes.
Main Results:
- The modified DGS incorporated 1879 ICD-10 codes, with 57.4% mapped via GEM and conversion tools.
- An additional 42.6% of codes were assigned through Delphi surveys and expert consensus.
- The system covers 98.7% and 95.2% of diagnoses from 2008 and 2009 data, respectively, showing strong construct validity and reflecting the H1N1 outbreak.
Conclusions:
- A clinically feasible and sensible DGS for pediatric emergent conditions in Korea has been developed and validated.
- The modified PECARN DGS demonstrates comprehensiveness and reliable construct validity.
- This adapted DGS can be effectively implemented for research, reporting, and resource planning in South Korea's pediatric emergency system.
Objective:
A clinically sensible diagnosis grouping system (DGS) is needed for describing pediatric emergency diagnoses for research, medical resource preparedness, and making national policy for pediatric emergency medical care. The Pediatric Emergency Care Applied Research Network (PECARN) developed the DGS successfully. We developed the modified PECARN DGS based on the different pediatric population of South Korea and validated the system to obtain the accurate and comparable epidemiologic data of pediatric emergent conditions of the selected population.
Methods:
The data source used to develop and validate the modified PECARN DGS was the National Emergency Department Information System of South Korea, which was coded by the International Classification of Diseases, 10th Revision (ICD-10) code system. To develop the modified DGS based on ICD-10 code, we matched the selected ICD-10 codes with those of the PECARN DGS by the General Equivalence Mappings (GEMs). After converting ICD-10 codes to ICD-9 codes by GEMs, we matched ICD-9 codes into PECARN DGS categories using the matrix developed by PECARN group. Lastly, we conducted the expert panel survey using Delphi method for the remaining diagnosis codes that were not matched.
Results:
A total of 1879 ICD-10 codes were used in development of the modified DGS. After 1078 (57.4%) of 1879 ICD-10 codes were assigned to the modified DGS by GEM and PECARN conversion tools, investigators assigned each of the remaining 801 codes (42.6%) to DGS subgroups by 2 rounds of electronic Delphi surveys. And we assigned the remaining 29 codes (4%) into the modified DGS at the second expert consensus meeting. The modified DGS accounts for 98.7% and 95.2% of diagnoses of the 2008 and 2009 National Emergency Department Information System data set. This modified DGS also exhibited strong construct validity using the concepts of age, sex, site of care, and seasons. This also reflected the 2009 outbreak of H1N1 influenza in Korea.
Conclusions:
We developed and validated clinically feasible and sensible DGS system for describing pediatric emergent conditions in Korea. The modified PECARN DGS showed good comprehensiveness and demonstrated reliable construct validity. This modified DGS based on PECARN DGS framework may be effectively implemented for research, reporting, and resource planning in pediatric emergency system of South Korea.
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