ICD-9 Diagnostic Codes Research Articles

Incidence and outcomes of cardiac tamponade in patients with breast cancer.

e13108 Background: Cardiac tamponade (CT) is a cardio-oncological emergency reported to be associated with poor outcomes in some solid tumors, such as lung cancers. There is a paucity of literary evidence on CT in patients with breast cancer. We sought to examine the Nationwide Inpatient Sample (NIS) -the largest inpatient database in the United States- to determine the incidence and factors associated with CT, and the in-hospital outcomes in patients with breast cancer. Methods: We retrospectively explored the NIS database collected from 2016 to 2020. Patients aged ≥ 18 with breast cancer and CT were selected using ICD-10 diagnostic codes. Univariate, multivariate logistic, and negative binomial regression models were used to assess the annual incidence trends, determine factors associated with cardiac tamponade and in-hospital outcomes among patients with breast cancer. Results: A total of 144,405 breast cancer patients (weighted n= 722,025) were examined, of which 345 (0.24%) had CT. The incidence of CT rose from 25 per 10 000 in 2016 to 27.3 per 10 000 cases of breast cancer in 2020 though this was not statistically significant (p=0.409). Patients with CT were more likely to be younger (60 ± 13 vs 66 ± 14, p<0.001), with comorbidity index ≥ 5 (90.72% vs 9.28%, p<0.0001), history of chemotherapy (18.84% vs 12.46%, p=0.0004), history of radiation therapy (17.97% vs 10.80%, p<0.0001), and had Medicare (50.43% vs 49.57%, p<0.001). After multivariate adjustment, comorbidity index ≥ 5 (aOR=5.16, 95% CI: 3.03 - 8.78; p<0.001), and history of irradiation (aOR=1.45, 95% CI: 1.08 - 1.96; p=0.014), were found to be independent predictors of CT. However, the risk of CT was less with age > 65 years (aOR=0.64, 95% CI: 0.47 - 0.87; p=0.004). Regarding in-hospital outcomes, after controlling for other covariates, CT was associated with an increased risk of mortality (aOR=1.71, 95% CI: 1.16 - 2.52; p=0.07) and longer hospital stay (7.25 ± 5.77 vs 4.78 ± 5.45; incidence risk ratio [IRR]:1.49, 95% CI: 1.36 - 1.63; p <0.001). Conclusions: Cardiac tamponade is rare in breast cancer and tends to occur more in patients who are younger, have comorbidities, and prior radiation therapy. It is associated with increased risk of in-hospital mortality and longer stay. Risk stratification of patients with breast cancer when deciding treatment is relevant to reduce the likelihood of CT and improve outcomes. Further studies are needed to establish the optimal management of CT in patients with breast cancer.

Adrenal insufficiency in patients on immune checkpoint inhibitors: An All of Us Data study.

e14675 Background: Immune Checkpoint Inhibitors have revolutionized the management of cancers. Several cases are reported about their adverse effects, which include adrenal insufficiency, a life-threatening irreversible sequela in some patients. Little has been done to evaluate the burden of this adverse effect on cancer patients. This study aimed to measure the incidence rate of adrenal insufficiency in patients on immune checkpoint inhibitors in the United States using the All Of Us database. Methods: In this cross-sectional study, we included participants from the All of Us dataset version 6, which includes data collected between May 6, 2018, and January 1, 2022, who had available Electronic Health Records data (N = 258,188). We defined the cancer cohort as having at least one ICD-9/ICD-10 diagnostic code for cancer. We identified participants in the cancer cohort without or with at least one exposure to immune checkpoint inhibitors nivolumab, pembrolizumab, cemiplimab, ipilimumab, atezolizumab, avelumab, durvalumab, tremelimumab, relatlimab, tremelimumab, pidilizumab. Adrenal insufficiency was defined as having one or more ICD-9/ICD-10 codes for any adrenal insufficiency after treatment with immune checkpoint inhibitors. The calculation for the Relative Risk(RR) was with unconditional maximum likelihood estimation. Results: Among 36,377 individuals diagnosed with cancer, 418 patients had exposure to immune checkpoint inhibitors. 44(10.5%) of the 418 were diagnosed with adrenal insufficiency after exposure to immune checkpoint inhibitors. The relative risk of adrenal insufficiency after the commencement of an immune checkpoint inhibitor is five times that of patients not on immune checkpoint inhibitors. (RR 5.43, 95% CI 4.07-7.25, P < 0.05). Conclusions: Our result suggests a higher incidence of adrenal insufficiency in cancer patients on immune checkpoint inhibitors compared to cancer patients, not on immune checkpoint inhibitors. Future prospective studies will be needed to confirm this finding. Physicians, particularly oncologists and endocrinologists, should have a high index of suspicion for adrenal insufficiency in patients on immune checkpoint inhibitors.

Association between atopic dermatitis, autoimmune illnesses, Epstein-Barr virus, and cytomegalovirus.

Atopic dermatitis (AD) is a Th2-driven inflammatory skin disease that has been associated with other autoimmune illnesses (AI) and has a well-known predisposition to infection with herpes simplex virus infection. Yet, few studies have evaluated the association between atopic dermatitis, autoimmune illness, and other human herpes virus (HHV) infections such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV). We aimed to evaluate the association between AD, specific AIs, CMV, and EBV in a random sample of the Optum Clinformatics Data Mart database, a US administrative claims database. AD was defined based on ICD diagnostic codes. Patients with AD were exact matched to those without AD on sex, age at enrollment, time observed in the dataset and census division. Our outcomes of interest were rheumatoid arthritis (RA), Crohn's disease (CD), ulcerative colitis (UC), multiple sclerosis (MS), CMV, and EBV infection as defined by specific ICD codes. Logistic regression models were used to examine the association between AD and our outcomes of interest [odds ratio (95% confidence intervals)]. Our full cohort included 40,141,017 patients. In total, 601,783 patients with AD were included. As expected, patients with AD had a higher prevalence of asthma and seasonal allergies versus controls. Individuals with AD have an increased risk of EBV, CMV, RA, CD, UC, and MS. While we cannot demonstrate a causal association, the observed associations between AD and AI may be in part mediated by these types of HHV (i.e., CMV and EBV), a finding that merits further study.

Groin Hernia Repair during the COVID-19 Pandemic-A Romanian Nationwide Analysis.

Background and Objectives: Groin hernia repair surgery (GHRS) is among the most common elective interventions. The aim of this three-year nationwide study on GHRS is to provide a thorough analysis of the impact that the COVID-19 pandemic had on the Romanian Health System in regard to elective procedures. Materials and Methods: 46,795 groin hernia cases obtained between 2019 and 2021 from the DRG database using ICD-10 diagnostic codes. The data were collected from all 261 GHRS performing hospitals nationwide, including 227 public hospitals (PbH) and 34 private hospitals (PvH). The 42 variables taken into account were processed using Microsoft Excel 2021, applying Chi square, F-Test Two-Sample for variances, and Two Sample t-Test. The significance threshold considered was p < 0.001. Results: Of the grand total of cases, 96.2% were inguinal hernias, 86.8% were performed on men, 15.2% were laparoscopic procedures, and 6.88% were in PvH. Overall, due to the pandemic, the total number of GHRS decreased with 44.45% in 2020 and with 29.72% in 2021 compared to pre-pandemic year 2019. April 2020 shows the steepest decrease in GHRS (91 procedures nationwide). In the private sector, there was an opposite trend with increases in the number of cases by 12.21% and a 70.22% in both pandemic years. The mean admission period (MAP) for all procedures was 5.5 days. There was a significant difference between PbH and PvH (5.75 vs. 2.8 days, p < 0.0001). During the pandemic, the MAP in PbH decreased (6.02 in 2019, 5.82 in 2020 and 5.3 in 2021), remaining stable for PvH (2.9 days in 2019, 2.85 days in 2020 and 2.74 days in 2021). Conclusions: The COVID-19 pandemic significantly reduced the overall number of GHRS performed in Romania in 2020 and 2021, compared to 2019. However, the private sector thrived with an actual increase in the number of cases. There was a significant lower MAP in the PvH compared to PbH throughout the three-year period.

PO-05-198 IN-HOSPITAL OUTCOMES OF PREGNANT WOMEN WITH LONG QT SYNDROME – INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE.

Patients admitted with a history of long QT syndrome (LQTS) have a higher all-cause mortality when compared to the general population, a trend especially pronounced among males. Conversely, in pregnant women the risk of potentially life-threatening events is lower during pregnancy but increases significantly during the 9-month postpartum period, however, limited data exists. To describe the baseline demographics and in-hospital outcomes of adult (≥ 18 years old) pregnant women with a previous diagnosis of LQTS. The National Inpatient Sample Database was queried from 2016-2019 for relevant ICD-10 diagnostic and procedural codes to construct our cohort. Outcomes of interest included frequency of ventricular tachycardia and in-hospital all-cause mortality. A total of 513,890 patients with a diagnosis of LQTS were identified, of which 3,285 (0.6%) were pregnant women (average age 28.8 years; 56% white). Asthma (13%) and obesity (12%) were the most common comorbidities, followed by heart failure (5%), diabetes mellitus (4%), OSA (1.4%), and coronary artery disease (1.4%). Substance use disorder was reported in 14% subjects and 15.6% had an implanted cardiac device at the time of admission. For obstetric comorbidities, the most common was preeclampsia (8%) and stillbirth (0.8%). There was a prevalence of 2% for ventricular tachycardia and 0.3% inpatient all-cause mortality. Among patients admitted with LQTS, pregnant women represent a significantly high-risk cohort for adverse cardiac and non-cardiac events for both mother and child. A multidisciplinary approach to identify these patients early is critical to improving maternal-fetal outcomes.

Trends in implementation of evidence-based hip fracture management in a major Canadian city.

The importance of hip fracture care has resulted in an abundance of hip fracture management literature. The degree this evidence is incorporated into clinical practice is unknown. We examined 5 trends in hip fracture management: arthroplasty versus fixation, total hip arthroplasty (THA) versus hemiarthroplasty (HA), cemented versus uncemented femoral stem fixation, short versus long cephalomedullary nail (CMN) fixation, and time from admission to surgery. Our primary aim was to understand and assess hip fracture management trends in relation to pertinent literature. Data were collected from acute hip fractures in patients aged 50 years or older who presented from 2008 to 2018. ICD-10 diagnostic codes were assigned using preoperative radiographs. Surgical management was confirmed using intraoperative and postoperative radiographs and split into 6 categories: (1) short CMN, (2) long CMN, (3) cannulated screws, (4) dynamic hip screw, (5) HA, and (6) THA. Appropriate statistical tests were used to analyze trends. In 4 assessed trends, hip fracture management aligned with high-level evidence. This was the case for a trend toward arthroplasty for displaced femoral neck fractures, increased use of THA relative to HA, increased use of short relative to long CMNs, and consistent decrease in surgical wait times. Despite the literature highlighting the disadvantages of uncemented femoral stems, our data demonstrated increased use of uncemented femoral stems. Evidence to guide orthopaedic practice is constantly emerging but may not be effectively used by clinicians. Our findings demonstrate the successes and failures of integrating evidence into hip fracture management and highlight that orthopaedic surgeons have an ongoing responsibility to strive for evidence-based practice.

The Association of Human Cytomegalovirus Infection and Colorectal Cancer: A Clinical Analysis

Human cytomegalovirus (HCMV) commonly infects humans and establishes lifelong infection. It causes disease and increased mortality rates in patients with immunosuppression. HCMV gene products are found to be present in multiple human malignancies and target cellular functions involved in tumor development; additionally, a tumor-cytoreductive role of CMV has also been observed. The purpose of this study was to evaluate the correlation between CMV infection and the incidence of colorectal cancer (CRC).The data were provided by a national database that is compliant with Health Insurance Portability and Accountability Act (HIPAA). Using International Classification of Disease (ICD)-10 and ICD-9 diagnostic codes, the data were filtered to evaluate patients infected with HCMV versus patients never infected with HCMV. Patient data from 2010 to 2019 were assessed. Access to the database was granted by Holy Cross Health, Fort Lauderdale for the purpose of academic research. Standard statistical methods were used.Between January 2010 and December 2019, the query was analyzed and resulted in 14,235 patients after matching in the infected and control groups. The groups were matched by age range, sex, Charlson Comorbidity Index (CCI) score, and treatment. The incidence of CRC was 1.159% (165 patients) in the HCMV group and 2.845% (405 patients) in the control group. The difference after matching was statistically significant by a P-value < 2.2 × 10-16 with an odds ratio of 0.37 (95% confidence interval (CI) 0.32 - 0.42).The study shows a statistically significant correlation between CMV infection and a reduced incidence of CRC. Further evaluation is recommended to assess the potential of CMV in reducing CRC incidence.

MP16-15 DISPARITIES IN INPATIENT CARE AND OUTCOMES FOR OLDER ADULTS WITH INFECTED STONES

You have accessJournal of UrologyCME1 Apr 2023MP16-15 DISPARITIES IN INPATIENT CARE AND OUTCOMES FOR OLDER ADULTS WITH INFECTED STONES Alexandria Spellman, Tetsu Ohnuma, Sonali Advani, Vijay Krishnamoorthy, Karthik Raghunathan, Kenneth Schmader, Michael Lipkin, Jodi Antonelli, and Charles D. Scales Alexandria SpellmanAlexandria Spellman More articles by this author , Tetsu OhnumaTetsu Ohnuma More articles by this author , Sonali AdvaniSonali Advani More articles by this author , Vijay KrishnamoorthyVijay Krishnamoorthy More articles by this author , Karthik RaghunathanKarthik Raghunathan More articles by this author , Kenneth SchmaderKenneth Schmader More articles by this author , Michael LipkinMichael Lipkin More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , and Charles D. ScalesCharles D. Scales More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003236.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: An obstructing urinary tract stone complicated by infection (septic stone) requires urgent intervention with both antibiotics and urinary tract decompression. Delayed treatment can lead to significant morbidity and sometimes mortality. Current published claims analyses reflect data up to 2011. Given a rapidly aging population and advances in critical care, we sought to examine characteristics and outcomes of patients with sepsis secondary to obstructing stones in a contemporary cohort, with a focus on outcomes in older adults. METHODS: We conducted a retrospective cohort study using data from the nationwide Premier Healthcare claims database (2016-2020) to identify hospital inpatients aged 18-95 treated for septic urolithiasis, using ICD-10 diagnostic codes consistent with sepsis with urinary stones. Baseline sociodemographic factors were described and stratified into 2 age groups: adults 65 years and older defined as “older adults”, and adults aged <65 years defined as the “younger cohort”. Outcomes such as length of stay, mortality, and discharge disposition were also compared in the 2 groups. RESULTS: The study cohort included 27,976 patients, of which 15,304 (54.7%) were older adults (Table 1). The average age of older adults was 76.0 (SD ±11.6) years, compared with 49.8 (SD ±7.3) years in younger cohort (p<0.001). Among older adults, 46.4% were male, versus 35.9% in the younger cohort; overall the cohort was predominantly non-Hispanic white (76.6%). Older adults were less likely to be cared for in teaching hospitals (p<0.001), and more likely to be cared for in smaller hospitals (<500 beds, p<0.001). Despite receiving more aggressive care (invasive mechanical ventilation, vasopressor use) and incurring higher costs (p<0.001), older adults experienced substantially higher mortality (RR 2.35, 95% confidence interval 2.1-2.7, p<0.001). In addition, older adults were significantly more likely to be discharged to a skilled nursing facility (31.8%) than younger adults (13.4%). CONCLUSIONS: Older adults hospitalized with septic stones have significantly worse outcomes, receive more aggressive care, and incur higher healthcare costs. Additional investigation is needed to identify patient, clinician, and facility-level drivers of these outcomes, so as to create pathways to reduce disparities and optimize outcomes for older adults. Source of Funding: Duke University © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e208 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandria Spellman More articles by this author Tetsu Ohnuma More articles by this author Sonali Advani More articles by this author Vijay Krishnamoorthy More articles by this author Karthik Raghunathan More articles by this author Kenneth Schmader More articles by this author Michael Lipkin More articles by this author Jodi Antonelli More articles by this author Charles D. Scales More articles by this author Expand All Advertisement PDF downloadLoading ...

Seasonal, Geographic, and Ethnic Influence on the Prevalence of Orofacial Clefts in Kuwait: A Nationwide Study.

Accurate nationwide epidemiological evidence is vital to study the seasonal, geographic, and ethnic influence on the trends of orofacial cleft prevalence in Kuwait. Data obtained from the National Center for Health Information and Ministry of Health Hospital digital records were reviewed retrospectively to identify patients with orofacial clefts (OFC) using the ICD-10 diagnostic codes. The Jonckheere-Terpstra test was used to assess the trend of birth prevalence across the different years. The associations of types of OFC with ethnic and geographic influences were tested with chi-square or Fisher's exact tests, while the strength of that association was tested with multi-nominal logistic regression. Birth prevalence in Kuwait ranged from 0.75-2.55 per 1000 live births (0.73- 2.73 among Kuwaitis, 0.60-3.27 among non-Kuwaitis), with no statistically significant change observed during the past 28 years. The risk of unilateral cleft lip and palate was eight times higher during summer compared to Autumn, while the risk of cleft lip and palate remained lower during winter. Jahra (OR-7.76, CI- 1.51-39.80), Farwaneya (OR-6.65, CI- 1.34-33.06), and Hawalli (OR-6.72, CI- 1.26-35.98) governorates had higher odds of bilateral cleft lip when compared to Mubarak Alkabeer. The study outcome is an indicator to improve patient care and customize healthcare infrastructure in the Ministry of Health. It also provides insight to develop projections of future needs. Future studies should focus on understanding the factors that might be a potential contributor to the seasonal change observed in the prevalence of OFC.

Translated article] Usefulness of ICD-10 diagnostic triggers to identify adverse drug events in emergency care

ObjectivesTo assess the usefulness of a tool based on ICD-10 diagnostic codes to identify patients who consult an emergency department for adverse drug events (ADE). MethodsProspective observational study, in which patients discharged from an emergency department during May to August 2022 with a diagnosis coded with one of the 27 ICD-10 diagnoses considered as triggers were included. ADE confirmation was carried out by analyzing drugs prescribed prior to admission, and through a discussion among experts and a phone interview with patients after hospital discharge. Results1143 patients with trigger diagnoses were evaluated, of which 310 (27.1%) corresponded to patients whose emergency visit was attributed to an ADE. A 58.4% of ADE consultations were found with three diagnostic codes: K59.0-Constipation (n = 87; 28.1%), I16.9-Hypertensive Crisis (n = 72; 23.2%) and I95.1-Orthostatic hypotension (n = 22; 7.1%). The diagnoses with the highest degree of association with consultations attributed to ADE were E16.2-Hypoglycemia, unspecified (73.7%) and E11.65-Type 2 diabetes mellitus with hyperglycemia (71.4%), while diagnoses D62-Acute posthemorrhagic anemia and I74.3-Embolism and thrombosis of arteries of the lower limbs were not attributed to any case of ADE. ConclusionsThe ICD-10 codes associated with trigger diagnoses are a useful tool to identify patients who consult the emergency services with ADE and could be used to apply secondary prevention programs to avoid new consultations to the health care system.

Electronic health record data for assessing risk of hospitalization for COVID-19: Methodological considerations applied to multiple sclerosis.

During the COVID-19 pandemic, electronic health record (EHR) data has been used to investigate disease severity and risk factors for severe COVID-19 in people with multiple sclerosis (pwMS). Methodological challenges including sampling bias, and residual confounding should be considered when conducting EHR-based studies. We aimed to address these limitations related to the use of EHR data in order to identify risk factors, including the use of disease modifying therapies (DMTs), associated with hospitalization for COVID-19 amongst pwMS. We performed a retrospective cohort study including a sample of 47,051 pwMS using a large US-based EHR and claims linked database. Follow-up started at the beginning of the pandemic, February 20th 2020, and continued until September 30th 2020. COVID-19 diagnosis was determined by the presence of ICD-10 diagnostic code for COVID-19, or a positive diagnostic laboratory test, or an ICD-10 diagnostic code for coronaviruses. We used Cox regression modeling to assess the impact of baseline demographics, MS disease history and pre-existing comorbidities on the risk of hospitalization for COVID-19. Then, we identified 5,169 pwMS using ocrelizumab (OCR) and 3,351 pwMS using dimethyl fumarate (DMF) at baseline, and evaluated the distribution of the identified COVID-19 risk factors between the two groups. Finally, we used Cox regression models, adjusted for the identified confounders, to estimate the risk of hospitalization for COVID-19 in pwMS treated with OCR compared to DMF. Among the pwMS cohort, we identified 799 COVID-19 cases (1.7%) which resulted in 182 hospitalizations for COVID-19 (0.4%). Population differences between the pwMS and COVID-19 cohorts were observed. Statistical modeling identified older age, male gender, African-American race, walking with assistance, non-ambulatory status, severe relapse requiring hospitalization in year prior to baseline, and specific comorbidities to be associated with a higher risk of COVID-19 related-hospitalization. Comparing the COVID-19 risk factors between OCR users and DMF users, MS characteristics including ambulatory status and MS subtype were highly imbalanced, likely arising from key differences in the labelled indications for these therapies. Compared to DMF use, in unadjusted (HR 1.58, 95% CI 0.73 - 3.44), adjusted (HR 1.28, 95% CI 0.58 - 2.83), propensity score weighted (HR 1.25, 95% CI 0.56 - 2.80), and doubly robust models (HR 1.29, 95% CI 0.57 - 2.89), no significantly increased risk of hospitalization for COVID-19 was associated with OCR use. We observed significant population differences when comparing all pwMS to COVID-19 cases, as well as significant differences in key confounders between OCR and DMF treated patients. In unadjusted analyses we did not observe a statistically significant higher risk of COVID-19 hospitalization in pwMS treated with OCR compared to DMF, with further attenuation of risk when adjusting for the key confounders. This study re-emphasises the importance to appropriately consider both sampling and confounding bias in EHR-based MS research.

Association of Primary Immunodeficiencies in Parents With Psychiatric Disorders and Suicidal Behavior in Their Offspring

Maternal immune activation (MIA) leading to altered neurodevelopment in utero is a hypothesized risk factor for psychiatric outcomes in offspring. Primary antibody immunodeficiencies (PIDs) constitute a unique natural experiment to test the MIA hypothesis of mental disorders. To assess the association of maternal and paternal PIDs with psychiatric disorders and suicidal behavior in offspring. Cohort study of 4 294 169 offspring of parents with and without PIDs living in Sweden at any time between 1973 and 2013. Data were extracted from Swedish nationwide health and administrative registers and were analyzed from May 5 to September 30, 2022. All individuals with diagnoses of PIDs identified between 1973 and 2013 from the National Patient Register were included. Offspring were included if born before 2003. Parent-offspring pairs in which both parents had a history of PIDs were excluded. Lifetime records of parental PIDs according to the International Classification of Diseases, Eighth Revision (ICD-8); International Classification of Diseases, Ninth Revision (ICD-9); and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes. Lifetime records of 10 psychiatric disorders and suicidal behavior identified using ICD-8, ICD-9, and ICD-10 diagnostic codes, including suicide attempts and death by suicide, among offspring. Covariates included sex, birth year, parental psychopathology, suicide attempts, and autoimmune diseases. Additional analyses excluded offspring with their own PIDs and autoimmune diseases. Poisson regression models were fitted separately for mothers and fathers to estimate incidence rate ratios (IRRs) and 95% CIs for the risk of psychiatric and suicidal behavior outcomes in the offspring of PID-exposed vs PID-unexposed mothers or fathers. The cohort included 4 294 169 offspring (2 207 651 males [51.4%]) and 3 954 937 parents (1 987 972 females [50.3%]). A total of 7270 offspring (0.17%) had parents with PIDs, and 4 286 899 offspring had parents without PIDs. In fully adjusted models, offspring of mothers with PIDs had an increased risk of any psychiatric disorder, while no such risks were observed in offspring of fathers with PIDs (IRR, 1.17; 95% CI, 1.10-1.25 vs IRR, 1.03; 95% CI, 0.94-1.14; P < .001). Likewise, an increased risk of suicidal behavior was observed among offspring of mothers with PIDs but not offspring of fathers with PIDs (IRR, 1.20; 95% CI, 1.06-1.36 vs IRR, 1.10; 95% CI, 0.91-1.34; P = .01). For the offspring of mothers with PIDs, the risk of developing any psychiatric disorder was significantly higher for those with mothers with 6 of 10 individual disorders, with IRRs ranging from 1.15 (95% CI, 1.04-1.26) for anxiety and stress-related disorders and 1.15 (95% CI, 1.03-1.30) for substance use disorders to 1.71 (95% CI, 1.37-2.14) for bipolar disorders. Offspring of mothers with both PIDs and autoimmune diseases had the highest risk for any psychiatric disorder (IRR, 1.24; 95% CI, 1.11-1.38) and suicidal behavior (IRR, 1.44; 95% CI, 1.17-1.78). Findings of this cohort study suggest that maternal, but not paternal, PIDs were associated with a statistically significant increased risk of psychiatric disorders and suicidal behavior in the offspring, particularly when PIDs co-occur with autoimmune diseases. These findings align with the MIA hypothesis of mental disorders, but the precise mechanisms remain to be elucidated.

External validation of the hospital frailty risk score among hospitalised home care clients in Canada: a retrospective cohort study.

The Hospital Frailty Risk Score (HFRS) is scored using ICD-10 diagnostic codes in administrative hospital records. Home care clients in Canada are routinely assessed with Resident Assessment Instrument-Home Care (RAI-HC) which can calculate the Clinical Frailty Scale (CFS) and the Frailty Index (FI). Measure the correlation between the HFRS, CFS and FI and compare prognostic utility for frailty-related outcomes. Retrospective cohort study. Alberta, British Columbia and Ontario, Canada. Home care clients aged 65+ admitted to hospital within 180days (median 65days) of a RAI-HC assessment (n = 167,316). Correlation between the HFRS, CFS and FI was measured using the Spearman correlation coefficient. Prognostic utility of each measure was assessed by comparing measures of association, discrimination and calibration for mortality (30days), prolonged hospital stay (10+ days), unplanned hospital readmission (30 days) and long-term care admission (1 year). The HFRS was weakly correlated with the FI (ρ 0.21) and CFS (ρ 0.28). Unlike the FI and CFS, the HFRS was unable to discriminate for 30-day mortality (area under the receiver operator characteristic curve (AUC) 0.506; confidence interval (CI) 0.502-0.511). It was the only measure that could discriminate for prolonged hospital stay (AUC 0.666; CI 0.661-0.673). The HFRS operated like the FI and CFI when predicting unplanned readmission (AUC 0.530 CI 0.526-0.536) and long-term care admission (AUC 0.600; CI 0.593-0.606). The HFRS identifies a different subset of older adult home care clients as frail than the CFS and FI. It has prognostic utility for several frailty-related outcomes in this population, except short-term mortality.

The incidence of Kawasaki disease using hospital admissions data for England 2006-2021.

To describe the incidence of Kawasaki Disease (kDa) between 2006 and 2021 in England. We identified all cases in hospital episode statistics with an ICD-10 diagnostic code M303 (for kDa) between 1 April 2006 and 31 March 2021. We validated 83 diagnoses using hospital medical records and found >97% accuracy. We calculated incidence rate ratios (IRRs) using Poisson regression and assessed the influence of age, sex, ethnicity and index of multiple deprivation (IMD). We used Office for National Statistics population estimates for England as the denominator. We identified a total of 5908 cases of kDa in all children under the age of 16 (mean age 3.8, s.d.=3.2, 95% CI: 3.7, 3.9). Incidence in children aged <5 years was 8.9 (95% CI: 8.6, 9.2)/100 000 person-years; in children aged 5-9, 2.4 (95% CI: 2.3, 2.6)/100 000 person-years; and in children aged 10-15, 0.6 (95% CI: 0.6, 0.7). Male:female ratio was 1.5:1. Incidence was higher among non-White than White ethnicities [adjusted IRR 2.1 (2.0-2.2) for Asian, 3.0 (2.8-3.3) for Black and 4.5 (4.2-4.8) for other ethnicities]. The incidence increased with socioeconomic deprivation; the adjusted IRR of the least deprived IMD quintile compared with the most deprived quintile was 0.81 (0.77-0.84). Incidence rates of kDa derived from hospital admission data in England were higher than in studies relying on clinician reporting. We confirm previous findings on the influence of sex and ethnicity on kDa incidence and observe that there was a higher incidence of kDa within more deprived socioeconomic groups.

Utilidad de los diagnósticos alertantes CIE-10 para identificar acontecimientos adversos por los medicamentos en los servicios de urgencias

ObjectivesTo assess the usefulness of a tool based on ICD-10 diagnostic codes to identify patients who consult an emergency department for adverse drug events (ADE). MethodsProspective observational study, in which patients discharged from an emergency department during May to August 2022 with a diagnosis coded with one of the 27 ICD-10 diagnoses considered as triggers were included. ADE confirmation was carried out by analyzing drugs prescribed prior to admission, and through a discussion among experts and a phone interview with patients after hospital discharge. Results1,143 patients with trigger diagnoses were evaluated, of which 310 (27.1%) corresponded to patients whose emergency visit was attributed to an ADE. A 58.4% of ADE consultations were found with three diagnostic codes: K59.0-Constipation (n = 87; 28.1%), I16.9-Hypertensive Crisis (n = 72; 23.2%) and I95.1-Orthostatic hypotension (n = 22; 7.1%). The diagnoses with the highest degree of association with consultations attributed to ADE were E16.2-Hypoglycemia, unspecified (73.7%) and E11.65-Type 2 diabetes mellitus with hyperglycemia (71.4%), while diagnoses D62-Acute posthemorrhagic anemia and I74.3-Embolism and thrombosis of arteries of the lower limbs were not attributed to any case of ADE. ConclusionsThe ICD-10 codes associated with trigger diagnoses are a useful tool to identify patients who consult the emergency services with ADE and could be used to apply secondary prevention programs to avoid new consultations to the health care system.

Using ICD-9 diagnostic codes for external validation of topic models derived from primary care electronic medical record clinical text data.

Background/Objectives: Unsupervised topic models are often used to facilitate improved understanding of large unstructured clinical text datasets. In this study we investigated how ICD-9 diagnostic codes, collected alongside clinical text data, could be used to establish concurrent-, convergent- and discriminant-validity of learned topic models. Design/Setting: Retrospective open cohort design. Data were collected from primary care clinics located in Toronto, Canada between 01/01/2017 through 12/31/2020. Methods: We fit a non-negative matrix factorization topic model, with K = 50 latent topics/themes, to our input document term matrix (DTM). We estimated the magnitude of association between each Boolean-valued ICD-9 diagnostic code and each continuous latent topical vector. We identified ICD-9 diagnostic codes most strongly associated with each latent topical vector; and qualitatively interpreted how these codes could be used for external validation of the learned topic model. Results: The DTM consisted of 382,666 documents and 2210 words/tokens. We correlated concurrently assigned ICD-9 diagnostic codes with learned topical vectors, and observed semantic agreement for a subset of latent constructs (e.g. conditions of the breast, disorders of the female genital tract, respiratory disease, viral infection, eye/ear/nose/throat conditions, conditions of the urinary system, and dermatological conditions, etc.). Conclusions: When fitting topic models to clinical text corpora, researchers can leverage contemporaneously collected electronic medical record data to investigate the external validity of fitted latent variable models.

Evaluation of the ICD-10 system in coding revascularisation procedures in patients with peripheral arterial disease in England: A retrospective cohort study using national administrative and clinical databases.

Many studies evaluating care in hospitals in England use the Hospital Episode Statistics (HES) administrative database. The aim of this study was to explore whether the International Classification of Diseases 10th Revision (ICD-10) system used by HES supported the evaluation of care received by patients with peripheral arterial disease (PAD) who had revascularisation. This retrospective cohort study used records on patients who had revascularisation for PAD between 1st January 2017 and 31st December 2019 in England, collected prospectively in the National Vascular Registry (NVR) and linked to HES. Patients were excluded if their NVR record did not have a match in HES, due to lack of consent or different admission and procedure dates. Agreement between different presentations of PAD recorded in the NVR and the ICD-10 diagnostic codes recorded in HES was evaluated using the unweighted Kappa statistic and sensitivity and specificity. Agreement between the NVR and HES was also assessed for gender, age, comorbidities, mode of admission, and procedure type and side. In total, 20,603 patients who had 24,621 admissions were included in the study. Agreement between NVR and HES on patient gender (Kappa=0.98), age (Kappa=0.98), mode of admission (Kappa=0.80), and procedure type and side (Kappa=0.92 and 0.87, respectively) was excellent. When all diagnostic fields in HES were explored, substantial agreement was observed for chronic ischaemia with tissue loss (Kappa=0.63), but it was lower for chronic ischaemia without tissue loss (Kappa=0.32) and acute limb ischaemia (Kappa=0.15). Agreement on comorbidities was mixed; excellent for diabetes (Kappa=0.82), moderate for chronic lung disease (Kappa=0.56), chronic kidney disease (Kappa=0.56), and ischaemic heart disease (Kappa=0.45) and fair for chronic heart failure (Kappa=0.35). The diagnostic ICD-10 codes currently used in HES cannot accurately differentiate between stages of PAD. Therefore, studies using HES to examine patterns of care and outcomes for patients with PAD are likely to suffer from misclassification bias. Adopting an extended ICD-10 system or the ICD-11 version released to the World Health Organisation member states in 2022, may overcome this problem. Healthcare Quality Improvement Partnership (HQIP).

Development of mental health disorders in endometrial cancer survivors and the impact on overall survival—a population-based cohort study

To better understand the risk of developing a mental health disorder and the association on outcomes in endometrial cancer patients. Endometrial cancer patients ≥18 years old diagnosed between 1997–2012 were identified from the Utah Population Database and matched with up to 5 cancer free women from the general population. Mental health disorders were identified by International Classification of Diseases ICD-9 diagnostic codes. Endometrial cancer survivors with pre-existing mental health issues were excluded. Diagnosis of a mental health disorder in endometrial cancer patients was compared with the endemic rate. The impact of a mental health disorders on overall survival (OS) and cause specific survival (CSS) was evaluated. There were 2941 endometrial cancer patients and 12,192 general population matched subjects that met criteria with a median follow up time of 7.1 years (range 0–19.2) and 7.7 years (0.4–19.2) respectively. Within the first 1.5 years from diagnosis, there was an association of endometrial cancer patients being diagnosed with a mental health disorder (Hazard radio (HR) 3.09, 95% confidence interval (CI) 2.66–3.59). However, no association was found in endometrial cancer patients being diagnosed with a mental health disorder between 1.5–3 years (HR 1.07, 95% CI 0.83–1.38) and ≥3 years (HR 1.09, 95% CI 0.95–1.26). Treatment with tri-modality (surgery, radiation and chemotherapy) and advanced disease was associated with mental health disorders. OS was worse in endometrial cancer survivors who developed an anxiety disorder (p = 0.0265). CSS was worse in endometrial cancer patients diagnosed with all mental health disorders and anxiety disorders (p &lt; 0.0001, p = 0.002). Endometrial cancer patients have an increased diagnosis of mental health disorders within the first 1.5 years of cancer diagnosis compared to the general population. Endometrial cancer survivors with anxiety disorder have worse OS. Anxiety disorders and all mental health disorders have a worse CSS.

Reduced risk of serious pneumococcal infections up to 10years after a dose of pneumococcal conjugate vaccine in established arthritis.

To examine rates of serious pneumococcal infections up to 10years after vaccination with 7-valent conjugated pneumococcal vaccine (PCV7) in patients with arthritis compared to non-vaccinated arthritis patients. In total, 595 adult arthritis patients (rheumatoid arthritis; RA=342, 80% women and spondylarthropathy; SpA=253, 45% women) received one dose of PCV7. Mean age/disease duration were 62/16 and 51/14years, respectively. For each patient, 4 matched reference subjects were identified. At vaccination, 420 patients received bDMARDs (anti-TNF=330, tocilizumab=15, abatacept=18, anakinra=1, rituximab=56). Methotrexate was given as monotherapy (n=86) or in combination with bDMARD (n=220). 89 SpA patients received NSAIDs without DMARD. The Skåne Healthcare Register was searched for ICD-10 diagnostic codes for pneumococcal infections (pneumonia, lower respiratory tract infection, septicemia, meningitis, septic arthritis) between January 2000 and December 2018. Frequency of infections after vs before vaccination were calculated (relative risks). Relative risk ratio (RRR) and relative risk reduction (1-RRR) were calculated comparing patients vs non-vaccinated references. Kaplan-Meier and Cox regression were used to investigate time to first event and predictors of infections. Among vaccinated RA and SpA patients, there was a significant relative risk reduction of pneumonia and all serious infections; 53% and 46%, respectively. There was no significant difference in time to first pneumonia or all serious infections after vaccination between patients and references. Higher age, RA diagnosis and concomitant prednisolone were associated with infections. One dose of pneumococcal conjugate vaccine may decrease risk of serious pneumococcal infection up to 10years in patients with arthritis receiving immunomodulating treatment.

1173. Increased risk of dementia in patients after Scrub typhus: a nationwide, population-based study in Korea

Abstract Background Scrub typhus causes systemic vasculitis and can lead to complications ranging from pneumonia and acute renal injury to meningitis or encephalitis. In South Korea, it occurs not only in rural areas but also in urban areas, and especially high in older people. We hypothesized that patients with scrub typhus are predisposed to increased risks for developing dementia. Methods We performed a population-based cohort study, in which persons aged between 60∼89 years, used the Health Insurance Review and Assessment database of South Korea between 2009 and 2018. The case definition of scrub typhus was based on the ICD-10 diagnostic code and prescription of doxycycline more than three days. Dementia was defined as patients with the code in expending benefit coverage or patients with the ICD-10 codes, examination codes and drug codes. The control group was selected as stratifying by age and gender at a ratio of 1:5 to the number of the case group in study population. Results During the observational periods, Of 76,073 patients had diagnosed with scrub typhus, 5,026 excluded due to diagnosed with scrub typhus during window period, with dementia or died before index date, 71,047 patients were included as case group. 355,235 patients were included as controls. During a mean follow-up of 5.6±2.9 years, 14,089 (19.8%) patients with previous scrub typhus and 61,807 (15.2%) controls had been developed dementia. Scrub typhus was significantly associated with dementia (adjusted hazard ratio [aHR], 1.12; 95% confidential interval [CI], 1.10-1.15, P&amp;lt; 0.001). Of dementia classification, the risk of Alzheimer dementia was significantly higher in the case group (17.8% vs 15.2%; aHR, 1.15; 95%CI, 1.13-1.18, p&amp;lt; 0.001), however, there was no significant difference in the risk of vascular dementia (2.1% vs 2.2%; aHR, 0.98; 95%CI, 0.83-1.16, p=0.82). Cumulative incidence of dementia during the follow-up period by the history of scrub typhus It shows in both groups dementia incidence increased over time and the case group had higher incident dementia compared with control group. Conclusion History of scrub typhus infection in elderly was associated with increased risk for dementia, especially Alzheimer’s dementia. Our results suggest that prevent measures of dementia could be improved by preventing and treating scrub typhus. Disclosures All Authors: No reported disclosures.