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Using Administrative Billing Codes to Identify Acute Musculoskeletal Infections in Children
Justin B Searns1,2, John D Rice3,4, Kaitlyn B Bertin3
1Department of Pediatrics, Section of Hospital Medicine.
Background And Objectives:
Acute hematogenous musculoskeletal infections (MSKI) are medical emergencies with the potential for life-altering complications in afflicted children. Leveraging administrative data to study pediatric MSKI is difficult as many infections are chronic, nonhematogenous, or occur in children with significant comorbidities. The objective of this study was to validate a case-finding algorithm to accurately identify children hospitalized with acute hematogenous MSKI using administrative billing codes.
Methods:
This was a multicenter validation study using the Pediatric Health Information System (PHIS) database. Hospital admissions for MSKI were identified from 6 PHIS hospitals using discharge diagnosis codes. A random subset of admissions underwent manual chart review at each site using predefined criteria to categorize each admission as either "acute hematogenous MSKI" (AH-MSKI) or "not acute hematogenous MSKI." Ten unique coding algorithms were developed using billing data. The sensitivity and specificity of each algorithm to identify AH-MSKI were calculated using chart review categorizations as the reference standard.
Results:
Of the 492 admissions randomly selected for manual review, 244 (49.6%) were classified as AH-MSKI and 248 (50.4%) as not acute hematogenous MSKI. Individual algorithm performance varied widely (sensitivity 31% to 91%; specificity 52% to 98%). Four algorithms demonstrated potential for future use with receiver operating characteristic area under the curve greater than 80%.
Conclusions:
Identifying children with acute hematogenous MSKI based on discharge diagnosis alone is challenging as half have chronic or nonhematogenous infections. We validated several case-finding algorithms using administrative billing codes and detail them here for future use in pediatric MSKI outcomes.
Insights
Validating algorithms to identify pediatric acute hematogenous musculoskeletal infections (MSKI) using administrative data is crucial. Four algorithms showed promise for accurately identifying these serious childhood infections in hospital billing records.
Area of Science:
- Pediatric infectious diseases
- Health informatics
- Clinical epidemiology
Background:
- Acute hematogenous musculoskeletal infections (MSKI) are pediatric emergencies with severe potential complications.
- Studying pediatric MSKI using administrative data is challenging due to chronic, nonhematogenous, or comorbid cases.
- Accurate identification of acute hematogenous MSKI is vital for research and patient outcomes.
Purpose of the Study:
- To validate a case-finding algorithm for identifying children hospitalized with acute hematogenous MSKI.
- To assess the accuracy of administrative billing codes in detecting these infections.
- To develop reliable methods for using administrative data in pediatric MSKI research.
Main Methods:
- Multicenter validation study using the Pediatric Health Information System (PHIS) database.
- Manual chart review of hospital admissions to categorize MSKI cases.
- Development and testing of ten unique algorithms using billing data.
- Calculation of sensitivity and specificity for each algorithm against chart review data.
Main Results:
- Nearly half (49.6%) of reviewed admissions were classified as acute hematogenous MSKI.
- Algorithm performance varied significantly, with sensitivities from 31% to 91% and specificities from 52% to 98%.
- Four algorithms achieved a receiver operating characteristic area under the curve greater than 80%, indicating strong potential.
Conclusions:
- Discharge diagnosis alone is insufficient for identifying acute hematogenous MSKI in children.
- Validated algorithms using administrative billing codes can improve the identification of pediatric MSKI.
- These algorithms offer a valuable tool for future research on pediatric MSKI outcomes.
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