ICD-10-CM-Based Definitions for Emergency Department Opioid Poisoning Surveillance: Electronic Health Record Case Confirmation Study

Details

• Personal Author:
  Akpunonu, Peter ; Bunn, Terry L. ; Costich, Julia F. ; Eustice, Sarah ; Martin, Julia ; Martinez, Pedro ; Pasalic, Emilia ; Quesinberry, Dana ; Slavova, Svetla
• Description:
  Objectives: Valid opioid poisoning morbidity definitions are essential to the accuracy of national surveillance. The goal of our study was to estimate the positive predictive value (PPV) of case definitions identifying emergency department (ED) visits for heroin or other opioid poisonings, using billing records with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Methods: We examined billing records for ED visits from 4 health care networks (12 EDs) from October 2015 through December 2016. We conducted medical record reviews of representative samples to estimate the PPVs and 95% confidence intervals (CIs) of (1) first-listed heroin poisoning diagnoses (n = 398), (2) secondary heroin poisoning diagnoses (n = 102), (3) first-listed other opioid poisoning diagnoses (n = 452), and (4) secondary other opioid poisoning diagnoses (n = 103). Results: First-listed heroin poisoning diagnoses had an estimated PPV of 93.2% (95% CI, 90.0%-96.3%), higher than secondary heroin poisoning diagnoses (76.5%; 95% CI, 68.1%-84.8%). Among other opioid poisoning diagnoses, the estimated PPV was 79.4% (95% CI, 75.7%-83.1%) for first-listed diagnoses and 67.0% (95% CI, 57.8%-76.2%) for secondary diagnoses. Naloxone was administered in 867 of 1055 (82.2%) cases; 254 patients received multiple doses. One-third of all patients had a previous drug poisoning. Drug testing was ordered in only 354 cases. Conclusions: The study findings suggest that heroin or other opioid poisoning surveillance definitions that include multiple diagnoses (first-listed and secondary) would identify a high percentage of true-positive cases. [Description provided by NIOSH]
• Subjects:
  Emergency Responders Morbidity Mortality Occupational Health Safety
• Keywords:
  Author Keywords: Case Definition Drugs Emergency Treatment Heroin Heroin Poisoning Morbidity Rates Mortality Rates Opioid Poisoning Positive Predictive Value Sampling Statistical Analysis Surveillance

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• ISSN:
  0033-3549
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  Georgia ; Kentucky ; OSHA Region 4
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  8 pdf pages
• Volume:
  135
• Issue:
  2
• NIOSHTIC Number:
  nn:20066694
• Citation:
  Public Health Rep 2020 Mar/Apr; 135(2):262-269
• Contact Point Address:
  Svetla Slavova, PhD, University of Kentucky, Department of Biostatistics, Kentucky Injury Prevention and Research Center, 333 Waller Ave, Ste 242, Lexington, KY 40504
• Email:
  ssslav2@email.uky.edu
• CAS Registry Number:
  Heroin (CAS RN 561-27-3)
• Federal Fiscal Year:
  2020
• Performing Organization:
  University of Kentucky
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Public Health Reports
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:68ac3998eec06f1314f1fe6baa4c77f05ee4315a911a2d1f99dff5882da66a44e3120e68ba004ddda67524d57ecd6329053a1f97f302d745dbb728c324433daf
• Download URL:
  https://stacks.cdc.gov/view/cdc/230772/cdc_230772_DS1.pdf
• File Type:
  [PDF - 325.26 KB ]