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Searns JB, Rice JD, Bertin KB, Birkholz M, Barganier LB, Creech CB, Downes KJ, Hubbell BB, Kronman MP, Rolsma SL, Sydney GI, O'Leary ST, Parker SK, Dominguez SR. Using Administrative Billing Codes to Identify Acute Musculoskeletal Infections in Children. Hosp Pediatr 2023; 13:182-195. [PMID: 36601701 DOI: 10.1542/hpeds.2022-006821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
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.
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Affiliation(s)
- Justin B Searns
- Department of Pediatrics, Section of Hospital Medicine.,Department of Pediatrics, Section of Infectious Disease
| | - John D Rice
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, Colorado.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Kaitlyn B Bertin
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, Colorado
| | | | - Lori B Barganier
- Department of Pediatrics, Section of Infectious Disease, Washington University School of Medicine, St. Louis, Missouri
| | - C Buddy Creech
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin J Downes
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brittany B Hubbell
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio.,Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Matthew P Kronman
- Department of Pediatrics, Section of Infectious Diseases, University of Washington, Seattle, Washington
| | - Stephanie L Rolsma
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Guy I Sydney
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sean T O'Leary
- Department of Pediatrics, Section of Infectious Disease.,Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, Colorado
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Jones YO, Hubbell BB, Thomson J, O’Toole JK. Things We Do for No Reason: Systemic Corticosteroids for Wheezing in Preschool-Aged Children. J Hosp Med 2019; 14:774-776. [PMID: 31339838 PMCID: PMC6897538 DOI: 10.12788/jhm.3255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Wheezing is common in preschool-aged children (ages 2-5
years), with up to half in this age group having experienced a
wheezing episode and up to one-third, recurrent wheezing.1,2
Young children with wheezing require ED visits and hospitalizations
at much higher rates than older children and adults.3 Several
studies have also demonstrated that children in this age
group have higher rates of SCS prescriptions compared with
older children.4,5 Despite the high prevalence of wheezing in
this age group, there is great heterogeneity in the etiology and
clinical progression of early childhood wheezing, with up to six
described phenotypes each with varying levels of association
with the development of asthma.6 Given the high frequency of
asthma, preschool-aged children admitted with wheezing are
often treated with SCS, as this is the standard of care for an
acute asthma exacerbation.7
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Affiliation(s)
- Yemisi O Jones
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Corresponding Author: Yemisi O Jones, MD; E-mail: ; Telephone: 412-965-9630
| | - Brittany B Hubbell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Joanna Thomson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer K O’Toole
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
- University of Cincinnati Medical Center, Cincinnati, Ohio
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