How well do discharge diagnoses identify hospitalised patients with community-acquired infections?--a validation study.

<h4>Background</h4>Credible measures of disease incidence, trends and mortality can be obtained through surveillance using manual chart review, but this is both time-consuming and expensive. ICD-10 discharge diagnoses are used as surrogate markers of infection, but knowledge on the valid...

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Autores principales:	Daniel Pilsgaard Henriksen, Stig Lønberg Nielsen, Christian Borbjerg Laursen, Jesper Hallas, Court Pedersen, Annmarie Touborg Lassen
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/0ec4ba6431374704a5ed78b551d6028b
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spelling	oai:doaj.org-article:0ec4ba6431374704a5ed78b551d6028b2021-11-18T08:26:33ZHow well do discharge diagnoses identify hospitalised patients with community-acquired infections?--a validation study.1932-620310.1371/journal.pone.0092891https://doaj.org/article/0ec4ba6431374704a5ed78b551d6028b2014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24663388/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Credible measures of disease incidence, trends and mortality can be obtained through surveillance using manual chart review, but this is both time-consuming and expensive. ICD-10 discharge diagnoses are used as surrogate markers of infection, but knowledge on the validity of infections in general is sparse. The aim of the study was to determine how well ICD-10 discharge diagnoses identify patients with community-acquired infections in a medical emergency department (ED), overall and related to sites of infection and patient characteristics.<h4>Methods</h4>We manually reviewed 5977 patients admitted to a medical ED in a one-year period (September 2010-August 2011), to establish if they were hospitalised with community-acquired infection. Using the manual review as gold standard, we calculated the sensitivity, specificity, predictive values, and likelihood ratios of discharge diagnoses indicating infection.<h4>Results</h4>Two thousand five hundred eleven patients were identified with community-acquired infection according to chart review (42.0%, 95% confidence interval [95%CI]: 40.8-43.3%) compared to 2550 patients identified by ICD-10 diagnoses (42.8%, 95%CI: 41.6-44.1%). Sensitivity of the ICD-10 diagnoses was 79.9% (95%CI: 78.1-81.3%), specificity 83.9% (95%CI: 82.6-85.1%), positive likelihood ratio 4.95 (95%CI: 4.58-5.36) and negative likelihood ratio 0.24 (95%CI: 0.22-0.26). The two most common sites of infection, the lower respiratory tract and urinary tract, had positive likelihood ratios of 8.3 (95%CI: 7.5-9.2) and 11.3 (95%CI: 10.2-12.9) respectively. We identified significant variation in diagnostic validity related to age, comorbidity and disease severity.<h4>Conclusion</h4>ICD-10 discharge diagnoses identify specific sites of infection with a high degree of validity, but only a moderate degree when identifying infections in general.Daniel Pilsgaard HenriksenStig Lønberg NielsenChristian Borbjerg LaursenJesper HallasCourt PedersenAnnmarie Touborg LassenPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 3, p e92891 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Daniel Pilsgaard Henriksen Stig Lønberg Nielsen Christian Borbjerg Laursen Jesper Hallas Court Pedersen Annmarie Touborg Lassen How well do discharge diagnoses identify hospitalised patients with community-acquired infections?--a validation study.
description	<h4>Background</h4>Credible measures of disease incidence, trends and mortality can be obtained through surveillance using manual chart review, but this is both time-consuming and expensive. ICD-10 discharge diagnoses are used as surrogate markers of infection, but knowledge on the validity of infections in general is sparse. The aim of the study was to determine how well ICD-10 discharge diagnoses identify patients with community-acquired infections in a medical emergency department (ED), overall and related to sites of infection and patient characteristics.<h4>Methods</h4>We manually reviewed 5977 patients admitted to a medical ED in a one-year period (September 2010-August 2011), to establish if they were hospitalised with community-acquired infection. Using the manual review as gold standard, we calculated the sensitivity, specificity, predictive values, and likelihood ratios of discharge diagnoses indicating infection.<h4>Results</h4>Two thousand five hundred eleven patients were identified with community-acquired infection according to chart review (42.0%, 95% confidence interval [95%CI]: 40.8-43.3%) compared to 2550 patients identified by ICD-10 diagnoses (42.8%, 95%CI: 41.6-44.1%). Sensitivity of the ICD-10 diagnoses was 79.9% (95%CI: 78.1-81.3%), specificity 83.9% (95%CI: 82.6-85.1%), positive likelihood ratio 4.95 (95%CI: 4.58-5.36) and negative likelihood ratio 0.24 (95%CI: 0.22-0.26). The two most common sites of infection, the lower respiratory tract and urinary tract, had positive likelihood ratios of 8.3 (95%CI: 7.5-9.2) and 11.3 (95%CI: 10.2-12.9) respectively. We identified significant variation in diagnostic validity related to age, comorbidity and disease severity.<h4>Conclusion</h4>ICD-10 discharge diagnoses identify specific sites of infection with a high degree of validity, but only a moderate degree when identifying infections in general.
format	article
author	Daniel Pilsgaard Henriksen Stig Lønberg Nielsen Christian Borbjerg Laursen Jesper Hallas Court Pedersen Annmarie Touborg Lassen
author_facet	Daniel Pilsgaard Henriksen Stig Lønberg Nielsen Christian Borbjerg Laursen Jesper Hallas Court Pedersen Annmarie Touborg Lassen
author_sort	Daniel Pilsgaard Henriksen
title	How well do discharge diagnoses identify hospitalised patients with community-acquired infections?--a validation study.
title_short	How well do discharge diagnoses identify hospitalised patients with community-acquired infections?--a validation study.
title_full	How well do discharge diagnoses identify hospitalised patients with community-acquired infections?--a validation study.
title_fullStr	How well do discharge diagnoses identify hospitalised patients with community-acquired infections?--a validation study.
title_full_unstemmed	How well do discharge diagnoses identify hospitalised patients with community-acquired infections?--a validation study.
title_sort	how well do discharge diagnoses identify hospitalised patients with community-acquired infections?--a validation study.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/0ec4ba6431374704a5ed78b551d6028b
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How well do discharge diagnoses identify hospitalised patients with community-acquired infections?--a validation study.

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