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Sensitivity of ICD coding for sepsis in children-a population-based study
Olga Endrich1,2, Karen Triep2, Luregn J Schlapbach3,4
1Bern, Switzerland Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern.
Insights
International Classification of Diseases 10th edition (ICD-10) coding poorly captures pediatric sepsis cases. This study found ICD-10 underestimates sepsis prevalence in children, highlighting a critical gap in disease burden assessment.
Area of Science:
- Pediatric infectious diseases
- Health informatics
- Epidemiology
Background:
- The International Classification of Diseases 10th edition (ICD-10) is a standard tool for disease burden assessment.
- Accurate coding is crucial for understanding disease prevalence and guiding public health interventions.
Purpose of the Study:
- To evaluate the accuracy of ICD-10 coding in identifying pediatric sepsis cases.
- To compare ICD-10 coding with validated research data for sepsis and related conditions in hospitalized children.
Main Methods:
- A secondary analysis of a prospective, multicenter cohort study involving nine Swiss pediatric hospitals.
- Comparison of validated sepsis criteria data with ICD-10 coding abstraction for 998 hospital admissions of children with blood culture-proven sepsis.
Main Results:
- ICD-10 coding sensitivity for sepsis was 60% (explicit) and 65% (implicit).
- Sensitivity for sepsis with organ dysfunction was only 35% (explicit).
- ICD-10 coding significantly underestimated the national incidence of pediatric sepsis compared to validated data.
Conclusions:
- ICD-10 coding provides a poor representation of sepsis and sepsis with organ dysfunction in children.
- Current ICD-10 coding practices may severely underestimate the true prevalence of pediatric sepsis.
- Improved coding strategies are needed for accurate pediatric sepsis surveillance.
Background:
International Classification of Diseases 10th edition (ICD-10) is widely used to describe the burden of disease.
Aim:
To describe how well ICD-10 coding captures sepsis in children admitted to the hospital with blood culture-proven bacterial or fungal infection and systemic inflammatory response syndrome.
Methods:
Secondary analysis of a population-based, multicenter, prospective cohort study on children with blood culture-proven sepsis of nine tertiary pediatric hospitals in Switzerland. We compared the agreement of validated study data on sepsis criteria with ICD-10 coding abstraction obtained at the participating hospitals.
Results:
We analyzed 998 hospital admissions of children with blood culture-proven sepsis. The sensitivity of ICD-10 coding abstraction was 60% (95%-CI 57-63) for sepsis; 35% (95%-CI 31-39) for sepsis with organ dysfunction, using an explicit abstraction strategy; and 65% (95%-CI 61-69) using an implicit abstraction strategy. For septic shock, the sensitivity of ICD-10 coding abstraction was 43% (95%-CI 37-50). Agreement of ICD-10 coding abstraction with validated study data varied by the underlying infection type and disease severity (p < 0.05). The estimated national incidence of sepsis, inferred from ICD-10 coding abstraction, was 12.5 per 100,000 children (95%-CI 11.7-13.5) and 21.0 per 100,000 children (95%-CI 19.8-22.2) using validated study data.
Conclusions:
In this population-based study, we found a poor representation of sepsis and sepsis with organ dysfunction by ICD-10 coding abstraction in children with blood culture-proven sepsis when compared against a prospective validated research dataset. Sepsis estimates in children based on ICD-10 coding may thus severely underestimate the true prevalence of the disease.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s44253-023-00006-1.
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