ICD9-CM Claims Data are Insufficient for Influenza Surveillance
Keywords:Influenza, biosurveillance, public health
Background: Influenza and Influenza like illness are representative of a class of epidemic infectious diseases that have important public health implications. Early detection via biosurveillance can speed lifesaving public heath responses. In the United States, biosurveillance is typically conducted using ICD9 coded visit diagnoses and uncoded chief complaint data.Â
Objective:Â To determine the accuracy of ICD9 diagnoses using laboratory confirmed cases as the gold standard.
Design:Â A six-year retrospective cohort study.
Setting:Â A tertiary referral center.
Patients:Â All 3,825 patients with an ICD9-CM diagnosis of Influenza and all 1455 patients with laboratory confirmed Influenza.
Results:Â Of the 3,828 patients assigned ICD9-CM visit codes indicating a diagnosis of Influenza, 2,825 were not confirmed by laboratory testing and 1,003 patients under went laboratory testing.Â Only 664 (66.2%) tested positive for Influenza.Â Of the 1,455 patients who tested positive for Influenza 45.6% were identified by ICD9-CM code.
Conclusion:Â ICD9-CM had a low 66.2% Positive Predictive Value (precision) for Influenza and a low 45.6% Sensitivity (recall) for Influenza in patients tested for Influenza. ICD9 coded visit diagnoses / claims data are insufficient alone to serve as the basis for Influenza Surveillance.
US Centers for Disease Control and Prevention. CDC Seasonal Influenza (Flu) - Flu Activity and Surveillance. US Centers for Disease Control; 2011.
Call SA, Vollenweider MA, Hornung CA, Simel DL, McKinney WP. Does this patient have influenza? JAMA. 2005;293(8):987-97.
Teodoro D, Pasche E, Gobeill J, Emonet S, Ruch P, Lovis C. Building a transnational biosurveillance network using semantic web technologies: requirements, design, and preliminary evaluation. J Med Internet Res. 2012 May 29;14(3):e73.
Elkin PL, Froehling D, Wahner-Roedler D, Brown SH, Bailey K. â€œComparison of NLP Biosurveillance Methods for Identifying Influenza from Encounter Notesâ€; Ann Intern Med. 2012 Jan 3;156(1 Pt 1):11-8.
Elkin PL, Brown SH, Balas A, Temesgen Z, Wahner-Roedler DL, Froehling D, Liebow M, Trusko B, Rosenbloom ST, Poland G. Biosurveillance evaluation of SNOMED CTâ€™s terminology (BEST Trial): coverage of chief complaints. Stud Health Technol Inform. 2008;136:797-802.
Adisasmito W, Chan PK, Lee N, Oner AF, Gasimov V, Aghayev F Zaman M, Bamgboye E, Dogan N, Coker R, Starzyk K, Dreyer NA, Toovey S. Effectiveness of antiviral treatment in human influenza A(H5N1) infections: analysis of a Global Patient Registry. J Infect Dis. 2010;202(8):1154-60.
Murff HJ, FitzHenry F, Matheny ME, Gentry N, Kotter KL, Crimin K, Dittus RS, Rosen AK, Elkin PL, Brown SH, Speroff T. Automated identification of postoperative complications within an electronic medical record using natural language processing. JAMA. 2011 Aug 24;306(8):848-55.
Brown SH, Elkin PL, Fielstein E, Speroff T. eQuality for all â€“ extending automated quality measurement from free text. AMIA Annu Symp Proc. 2008 Nov 6:71-5.
Brown SH, Speroff T, Fielstein EM, Bauer BA, Wahner-Roedler DL, Greevy R, Elkin PL. eQuality: Automatic assessment from narrative clinical reports. Mayo Clin Proc 2006 81(11):1472-1481
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under aÂ Creative Commons Attribution LicenseÂ that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeÂ The Effect of Open AccessÂ and Benefits of Publishing Open Access).