Drug overdose in the ED: a record linkage study examining emergency department ICD-10 coding practices in a cohort of people who inject drugs
Drug overdose in the ED: a record linkage study examining emergency department ICD-10 coding practices in a cohort of people who inject drugs
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DOI：
10.1186/s12913-018-3756-8
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发表时间：
2018-12-05
影响因子：
2.8
通讯作者：
Dietze, Paul
中科院分区：
文献类型：
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作者：
Di Rico, Rehana;Nambiar, Dhanya;Dietze, Paul
背景：药物过量是注射毒品者（PWID）死亡和发病的主要原因。药物过量监测通常依赖于国际疾病分类（ICD-10）编码系统，但其真实的世界使用和监测的影响尚未得到很好的表征。本研究探讨了ICD-10编码有关的模式，在急诊科药物过量的一个队列的已知PWID.Methods：队列数据从688 PWID链接到全州急诊科行政数据之间的2008年1月至2013年6月。ICD-10诊断代码有关中毒的药物，药物和生物物质（T-代码T36-T50），以及精神和行为障碍，由于精神活性物质的使用（F-代码F10-F19）进行了examined.Results：有449个独特的艾德介绍与T或F代码提到168个人。使用的T和F代码中近一半是非特异性的，未识别药物类别（n=160，36%）或临床反应（n=46，10%），8%代表戒断状态。因此，仅42%（n=188）的病例可使用T和F代码合理推断非法药物过量。大多数具有T或F药物过量代码的病例每次仅记录一个诊断代码（83%），代表多种药物过量（F19.-= 18%）或不明物质（T50.9=17%）使用一个单一的，广泛的诊断codes.Conclusions：依赖诊断单独检查时，艾德数据可能会显着低估特定药物过量的发生率，由于频繁使用的非特异性ICD-10代码和使用单一的诊断代码，以代表多物质过量。应考虑提高编码特异性的措施，并需要进一步的工作来确定在过量监测中使用艾德数据的最佳方法。
Background: Drug overdose is a leading cause of mortality and morbidity amongst people who inject drugs (PWID). Drug overdose surveillance typically relies on the International Classification of Diseases (ICD-10) coding system, however its real world utilisation and the implications for surveillance have not been well characterised. This study examines the patterns of ICD-10 coding pertaining to drug overdoses within emergency departments for a cohort of known PWID.Methods: Cohort data from 688 PWID was linked to statewide emergency department administrative data between January 2008 and June 2013. ICD-10 diagnostic codes pertaining to poisonings by drugs, medicaments and biological substances (T-codes T36-T50) as well as mental and behavioural disorders due to psychoactive substance use (F-codes F10-F19) were examined.Results: There were 449 unique ED presentations with T or F code mentions contributed by 168 individuals. Nearly half of the T and F codes used were non-specific and did not identify either a drug class (n=160, 36%) or clinical reaction (n=46, 10%) and 8% represented withdrawal states. T and F codes could therefore be used to reasonably infer an illicit drug overdose in only 42% (n=188) of cases. Majority of presentations with T or F overdose codes recorded only one diagnostic code per encounter (83%) and representing multiple-drug overdose (F19.-=18%) or unidentified substances (T50.9=17%) using a single, broad diagnostic code was common.Conclusions: Reliance on diagnoses alone when examining ED data will likely significantly underestimate incidence of specific drug overdose due to frequent use of non-specific ICD-10 codes and the use of single diagnostic codes to represent polysubstance overdose. Measures to improve coding specificity should be considered and further work is needed to determine the best way to use ED data in overdose surveillance.