Accuracy of Influenza ICD-10 Diagnosis Codes in Identifying Influenza Illness in Children

Author:

Antoon James W.1,Stopczynski Tess2,Amarin Justin Z.1,Stewart Laura S.1,Boom Julie A.3,Sahni Leila C.3,Michaels Marian G.4,Williams John V.4,Englund Janet A.5,Klein Eileen J.5,Staat Mary A.6,Schlaudecker Elizabeth P.6,Selvarangan Rangaraj7,Schuster Jennifer E.7,Weinberg Geoffrey A.8,Szilagyi Peter G.9,Perez Ariana10,Moline Heidi L.10,Spieker Andrew J.2,Grijalva Carlos G.11,Olson Samantha M.10,Halasa Natasha B.1

Affiliation:

1. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee

2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee

3. Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas

4. Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

5. Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington, Washington

6. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio

7. Department of Pediatrics, Children’s Mercy–Kansas City, Kansas City, Missouri

8. Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York

9. Department of Pediatrics, UCLA Mattel Children’s Hospital, Los Angeles, California

10. Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

11. Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee

Abstract

ImportanceStudies of influenza in children commonly rely on coded diagnoses, yet the ability of International Classification of Diseases, Ninth Revision codes to identify influenza in the emergency department (ED) and hospital is highly variable. The accuracy of newer International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes to identify influenza in children is unknown.ObjectiveTo determine the accuracy of ICD-10 influenza discharge diagnosis codes in the pediatric ED and inpatient settings.Design, Setting, and ParticipantsChildren younger than 18 years presenting to the ED or inpatient settings with fever and/or respiratory symptoms at 7 US pediatric medical centers affiliated with the Centers for Disease Control and Prevention–sponsored New Vaccine Surveillance Network from December 1, 2016, to March 31, 2020, were included in this cohort study. Nasal and/or throat swabs were collected for research molecular testing for influenza, regardless of clinical testing. Data, including ICD-10 discharge diagnoses and clinical testing for influenza, were obtained through medical record review. Data analysis was performed in August 2023.Main Outcomes and MeasuresThe accuracy of ICD-10–coded discharge diagnoses was characterized using molecular clinical or research laboratory test results as reference. Measures included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Estimates were stratified by setting (ED vs inpatient) and age (0-1, 2-4, and 5-17 years).ResultsA total of 16 867 children in the ED (median [IQR] age, 2.0 [0.0-4.0] years; 9304 boys [55.2%]) and 17 060 inpatients (median [IQR] age, 1.0 [0.0-4.0] years; 9798 boys [57.4%]) were included. In the ED, ICD-10 influenza diagnoses were highly specific (98.0%; 95% CI, 97.8%-98.3%), with high PPV (88.6%; 95% CI, 88.0%-89.2%) and high NPV (85.9%; 95% CI, 85.3%-86.6%), but sensitivity was lower (48.6%; 95% CI, 47.6%-49.5%). Among inpatients, specificity was 98.2% (95% CI, 98.0%-98.5%), PPV was 82.8% (95% CI, 82.1%-83.5%), sensitivity was 70.7% (95% CI, 69.8%-71.5%), and NPV was 96.5% (95% CI, 96.2%-96.9%). Accuracy of ICD-10 diagnoses varied by patient age, influenza season definition, time between disease onset and testing, and clinical setting.Conclusions and RelevanceIn this large cohort study, influenza ICD-10 discharge diagnoses were highly specific but moderately sensitive in identifying laboratory-confirmed influenza; the accuracy of influenza diagnoses varied by clinical and epidemiological factors. In the ED and inpatient settings, an ICD-10 diagnosis likely represents a true-positive influenza case.

Publisher

American Medical Association (AMA)

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