Abstract
BackgroundDrug 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.MethodsCohort 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.ResultsThere 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.ConclusionsReliance 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.
Highlights
People who inject drugs (PWID) experience disproportionate morbidity and mortality related to their drug use [1, 2]
The software allocates the relevant International classification of diseases (ICD)-10 codes for each encounter by mapping the clinical diagnoses entered by clinicians in their discharge documentation to a significantly abridged set of International Classification of Diseases (ICD-10) codes accepted for Victorian Emergency Minimum Dataset (VEMD) reporting
Data are reported to VEMD with only minor input from local administrative staff. This is in contrast to hospital admitted episode data, which are collected by dedicated coding staff at each hospital who are trained to retrospectively review all clinical notes and encode data according to strict criteria, including ICD-10 code selection, for submission to the Victorian Admitted Episode Dataset
Summary
People who inject drugs (PWID) experience disproportionate morbidity and mortality related to their drug use [1, 2]. In particular, is a leading cause of mortality amongst PWID [1]. Monitoring overdose occurrence presents a key surveillance target and a potential opportunity to inform interventions to reduce opioid related deaths. PWID frequently attend hospital emergency departments (EDs) [11], including for overdose-related presentations [12], and so ED data offer potential utility for surveillance and a rich source of information on drug-related morbidity. Drug overdose is a leading cause of mortality and morbidity amongst people who inject drugs (PWID). This study examines the patterns of ICD-10 coding pertaining to drug overdoses within emergency departments for a cohort of known PWID
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