Abstract
BackgroundUnderstanding emergency department and healthcare utilisation related to acute recreational drug toxicity (ARDT) generally relies on nationally collated data based on ICD-10 coding. Previous UK studies have shown this poorly captures the true ARDT burden. The aim of this study was to investigate whether this is also the case elsewhere in Europe.MethodsThe Euro-DEN Plus database was interrogated for all presentations 1st July to 31st December 2015 to the EDs in (i) St Thomas’ Hospital, London, UK; (ii) Universitätsspital Basel, Basel, Switzerland; and (iii) Zealand University Hospital, Roskilde, Denmark. Comparison of the drug(s) involved in the presentation with the ICD-10 codes applied to those presentations was undertaken to determine the proportion of cases where the primary/subsequent ICD-10 code(s) were ARDT related.ResultsThere were 619 presentations over the 6-month period. Two hundred thirteen (34.4%) of those presentations were coded; 89.7% had a primary/subsequent ARDT-related ICD-10 code. One hundred percent of presentations to Roskilde had a primary ARDT ICD-10 code compared to 9.6% and 18.9% in Basel and London respectively. Overall, only 8.5% of the coded presentations had codes that captured all of the drugs that were involved in that presentation.ConclusionsWhile the majority of primary and secondary codes applied related to ARDT, often they did not identify the actual drug(s) involved. This was due to both inconsistencies in the ICD‐10 codes applied and lack of ICD‐10 codes for the drugs/NPS. Further work and education is needed to improve consistency of use of current ICD‐10 and future potential ICD‐11 coding systems.
Highlights
The International Classification of Disease version 10 (ICD10) system is often used to code hospital outpatient attendances, emergency department (ED) attendances and hospital discharges and used to understand the burden on healthcare systems related to specific diseases/medical conditions [1]
The Hospital Episode Statistics (HES) in the UK collate over 125 million ICD-10 coded episodes per year and HES data is used to demonstrate the prevalence of different medical conditions across the UK, as well as for planning and funding health service provision [1]
Over three quarters of acute recreational drug toxicity (ARDT) patients are discharged directly from the ED, and since they are not admitted to hospital, they are not captured by the ICD-10 coding system [4]
Summary
ICD-10 coding can generate representative data for routine surgical admissions to hospital and for general medical conditions (for example, cancer and heart disease), previous UK studies have shown it is less robust at capturing recreational drugrelated burden of health care utilisation [2, 3]. Over three quarters of acute recreational drug toxicity (ARDT) patients are discharged directly from the ED, and since they are not admitted to hospital, they are not captured by the ICD-10 coding system [4]. Understanding emergency department and healthcare utilisation related to acute recreational drug toxicity (ARDT) generally relies on nationally collated data based on ICD-10 coding. Comparison of the drug(s) involved in the presentation with the ICD-10 codes applied to those presentations was undertaken to determine the proportion of cases where the primary/subsequent ICD-10 code(s) were ARDT related. Only 8.5% of the coded presentations had codes that captured all of the drugs that were involved in that presentation
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