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Accuracy of Diagnostic Codes for Identifying Brief Resolved Unexplained Events
Amy M DeLaroche1, Matt Hall2, Manoj K Mittal3
1Children's Hospital of Michigan, Detroit, Michigan adelaroc@dmc.org.
Insights
Identifying brief resolved unexplained events (BRUE) in infants requires specific ICD-10 coding strategies. The BRUE code is effective for emergency department discharges, while characteristic codes are better for hospitalized patients.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Informatics
- Health Services Research
Background:
- Brief Resolved Unexplained Events (BRUE) are common in infants presenting to emergency departments.
- Accurate identification of BRUE cases is crucial for appropriate clinical management and research.
- International Classification of Diseases, 10th Revision (ICD-10) codes are used for patient data abstraction.
Purpose of the Study:
- To evaluate the effectiveness of different ICD-10 coding strategies for identifying patients with BRUE.
- To compare the performance of various ICD-10 code combinations in a real-world clinical setting.
Main Methods:
- A multicenter retrospective cohort study of infants (<1 year) with emergency department visits was conducted.
- Sixteen algorithms using ICD-10 codes for BRUE, its characteristics, and related diagnoses were developed.
- Manual chart review validated the ICD-10 algorithms against the American Academy of Pediatrics BRUE definition.
Main Results:
- Of 4512 records, 36.5% met BRUE criteria; 61.7% were hospitalized, and 58.3% had no explanation at discharge.
- For ED discharges, the BRUE ICD-10 code alone showed high sensitivity (89.8%-92.8%).
- For hospitalized patients, ICD-10 codes for BRUE characteristics offered higher specificity (93.2%).
Conclusions:
- The choice of ICD-10 coding strategy for BRUE depends on the study's objective and patient population.
- Using the BRUE ICD-10 code is optimal for identifying cases among ED discharges.
- Codes for BRUE characteristics are recommended for hospitalized patients to improve accuracy.
Objectives:
To evaluate International Classification of Diseases, 10th Revision (ICD-10) coding strategies for the identification of patients with a brief resolved unexplained event (BRUE).
Methods:
Multicenter retrospective cohort study, including patients aged <1 year with an emergency department (ED) visit between October 1, 2015, and September 30, 2018, and an ICD-10 code for the following: (1) BRUE; (2) characteristics of BRUE; (3) serious underlying diagnoses presenting as a BRUE; and (4) nonserious diagnoses presenting as a BRUE. Sixteen algorithms were developed by using various combinations of these 4 groups of ICD-10 codes. Manual chart review was used to assess the performance of these ICD-10 algorithms for the identification of (1) patients presenting to an ED who met the American Academy of Pediatrics clinical definition for a BRUE and (2) the subset of these patients discharged from the ED or hospital without an explanation for the BRUE.
Results:
Of 4512 records reviewed, 1646 (36.5%) of these patients met the American Academy of Pediatrics criteria for BRUE on ED presentation, 1016 (61.7%) were hospitalized, and 959 (58.3%) had no explanation on discharge. Among ED discharges, the BRUE ICD-10 code alone was optimal for case ascertainment (sensitivity: 89.8% to 92.8%; positive predictive value: 51.7% to 72.0%). For hospitalized patients, ICD-10 codes related to the clinical characteristics of BRUE are preferred (specificity 93.2%, positive predictive value 32.7% to 46.3%).
Conclusions:
The BRUE ICD-10 code and/or the diagnostic codes for the characteristics of BRUE are recommended, but the choice between approaches depends on the investigative purpose and the specific BRUE population and setting of interest.
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