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Accuracy of pathogen diagnostic codes for acute hematogenous musculoskeletal infections in children
Justin B Searns1,2, Matt Hall3, Meghan Birkholz2
1Department of Pediatrics, Section of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
Abstract:
Administrative databases are powerful tools for pediatric research but lack patient-level microbiology results. This study aimed to determine the accuracy of pathogen discharge diagnosis codes for children hospitalized with acute hematogenous musculoskeletal infections (MSKIs). Medical records for 244 children hospitalized with acute hematogenous MSKIs were manually reviewed to determine which bacterial pathogen, if any, was identified for each MSKI based on microbiology results obtained during the hospitalization. Microbiology results for each patient were then compared to their discharge diagnoses in the Pediatric Health Information System (PHIS) database to determine the accuracy of pathogen discharge codes. Discharge diagnostic codes correctly matched the microbiology results in 89.3% of encounters. Sensitivity and specificity for Staphylococcus aureus discharge diagnostic codes were 88.6% and 96.4% respectively for methicillin-susceptible S. aureus and 92.9% and 99.5% for methicillin-resistant S. aureus. Pathogen discharge codes are reliable surrogates that accurately reflect the microbiology results for children with MSKIs.
Insights
Administrative databases accurately code pathogens in pediatric musculoskeletal infections (MSKIs). Discharge diagnosis codes reliably reflect microbiology results for hospitalized children, aiding research.
Area of Science:
- Pediatric infectious diseases
- Health informatics
- Clinical microbiology
Background:
- Administrative databases are valuable for pediatric research.
- These databases often lack detailed patient-level microbiology data.
- Accurate coding is crucial for reliable data analysis.
Purpose of the Study:
- To assess the accuracy of pathogen discharge diagnosis codes in administrative databases.
- To evaluate the reliability of these codes for children with acute hematogenous musculoskeletal infections (MSKIs).
Main Methods:
- Manual review of medical records for 244 children with MSKIs.
- Comparison of identified bacterial pathogens from microbiology results with discharge diagnosis codes in the Pediatric Health Information System (PHIS) database.
- Calculation of sensitivity and specificity for Staphylococcus aureus codes.
Main Results:
- Discharge diagnosis codes accurately matched microbiology results in 89.3% of cases.
- High sensitivity and specificity were observed for Staphylococcus aureus codes (e.g., 92.9% sensitivity and 99.5% specificity for MRSA).
- Pathogen discharge codes were found to be reliable surrogates for microbiology results.
Conclusions:
- Pathogen discharge diagnosis codes are reliable for pediatric MSKI research.
- These codes accurately reflect underlying microbiology findings.
- Administrative data can be effectively utilized for pediatric infectious disease research with confidence in pathogen coding.
