Changing diagnosis coding routines may confound the results of longitudinal childhood pneumonia studies
Margareta Eriksson1, Anna Nilsson1, Rutger Bennet1
1Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Insights
The introduction of the pneumococcal conjugate vaccine in Sweden did not definitively reduce bacterial pneumonia rates in young children, as diagnosis coding changes complicated analysis. Further research should account for these coding shifts.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Health informatics
Background:
- Acute lower respiratory tract infections (ALRIs) are a significant cause of childhood morbidity.
- The pneumococcal conjugate vaccine (PCV) was introduced in Sweden in 2007 to prevent pneumococcal disease.
- Accurate diagnosis coding is crucial for epidemiological studies.
Purpose of the Study:
- To compare discharge diagnosis codes for pediatric ALRIs before and after PCV introduction.
- To assess the impact of PCV on pneumonia and ALRI rates in children under five.
Main Methods:
- Retrospective analysis of International Classification of Diseases-10th revision (ICD-10) codes.
- Comparison of discharge diagnoses for children aged 0-5 years at Astrid Lindgren Children's Hospital.
- Data collected from two periods: July 2005-June 2007 and July 2011-June 2013.
Main Results:
- A 54% reduction in all-cause pneumonia was observed in infants (0-1 years) between the two periods.
- This reduction may be partly attributed to improved viral diagnosis and coding changes (e.g., RSV from pneumonia to bronchiolitis).
- The overall rate of ALRIs remained unchanged.
Conclusions:
- Solely using discharge codes, the specific impact of PCV on reducing bacterial pneumonia in infants could not be determined.
- Changes in diagnostic coding practices must be considered in longitudinal register studies.
- Further research using different methodologies is needed to clarify PCV's impact.
Aim:
This Swedish study compared the discharge diagnosis codes used for children up to the age of five hospitalised for acute lower respiratory tract infections before and after the introduction of the pneumococcal conjugate vaccine in 2007.
Methods:
The International Classification of Diseases-10th revision codes were used. We compared the discharge diagnosis codes at the Astrid Lindgren Children's Hospital from 1 July 2005 to 30 June 2007 (n=1,127) and 1 July 2011 to 30 June 2013 (n=1,240) in relation to the diagnostic methods used.
Results:
There was a 54% reduction in the rate of all-cause pneumonia from the first to the second period in children aged 0-1 years, but some of this could have been due to the improved diagnosis of viral infections and us changing the code for respiratory syncytial virus infection from pneumonia to bronchiolitis. The overall rate of acute lower respiratory tract infections was unchanged.
Conclusion:
We could not determine how much of the reduction in bacterial pneumonia in children under one was because of the introduction of the pneumococcal conjugate vaccine, based solely on discharge codes. Longitudinal register studies should take changes in diagnosis codes into account.
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