Accuracy of Diagnostic Codes for Identifying Brief Resolved Unexplained Events

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.