ICD-9 Diagnosis Codes Research Articles

Patient acceptance of teleneurology across neurologic conditions.

Patient acceptability with outpatient teleneurology has been reported within specific conditions, but less is known about acceptability across neurologic conditions. The study objective was to compare the acceptability of teleneurology between patients with various neurological conditions and determine what other factors influence acceptability. This was a prospective study of Veterans who completed new outpatient teleneurology visits with the Department of Veterans Affairs National Teleneurology Program. Visits were conducted via video to home or video to the outpatient clinic. Patient acceptability was assessed via telephone interview two weeks post-visit. Acceptability was a summed score (3-21) of three 7-point Likert questions (higher = more acceptable). Clinical diagnosis categories were based on the neurologists' ICD10 diagnosis code. Acceptability score was modeled using a censored Tobit model controlling for demographics, type of tele-visit, medical comorbidity, and ICD10 category. In FY 2021, 277 of 637 (43.5%) patients completed an interview with analyzable acceptability data. Of these 277, 70 (25.3%) had codes indicating headache, 46 (16.6%) movement disorder, 45 (16.2%) general symptoms, and 116 (41.9%) for all other categories. Mean patient acceptability was 18.3 (SD 3.2). There was no significant difference in scores between these groups. The only factor independently related to acceptability was medical comorbidity, with higher comorbidity associated with higher acceptability scores. Patients find their outpatient teleneurology experience highly acceptable independent of neurologic condition. Those with more comorbidity report higher acceptability. Use of teleneurology may be useful and acceptable across many outpatient neurologic conditions including for more medically complex patients.

Quantitative Analysis of Condition-based Limited Duty Duration of Musculoskeletal Conditions.

Musculoskeletal injuries affect nearly a million service members annually within the DoD, ultimately costing the U.S. Military half a billion dollars in direct patient costs and a significant loss to fleet readiness as many members are assigned days on limited duty (LIMDU) until they are deemed medically fit to return to duty (RTD). The new approach implemented by Navy Medicine in 2022, called "condition-based LIMDU," aims to drastically impact the time in which Sailors and Marines spend under a provider's care by assigning LIMDU days based on a standardized set of guidelines. This study provides a quantitative analysis on LIMDU duration, before and after implementation of the new condition-based LIMDU paradigm, to increase the understanding on the effectiveness and impact to fleet readiness and to assess the accuracy of suggested patient outcome timelines. De-identified and aggregated data were obtained from the Naval Medical Forces Atlantic's (NMFL) LIMDU Sailor and Marine Readiness Tracker System (SMART) program for all active duty military patients with ICD-10 code for musculoskeletal conditions. Only closed LIMDU cases in which active duty patients were given a final status of RTD were included. This study analyzed top musculoskeletal ICD-10 codes, optimum period (weeks), maximum period (weeks), and average days on LIMDU assigned at NMFL centers (medical and non-medical) for fiscal years 2021 (FY21) and 2022 (FY22). As well as descriptive statistics, t-test analysis was used to test if there was a difference between FY21 and FY22 and at what point the difference was no longer significant. Critical value method was then used to compare the top five most common musculoskeletal injuries to determine the accuracy of recommended LIMDU days to actual average assigned LIMDU per injury type. A color-coded compliance chart was created based on the results. The results showed that for RTD population, the implementation of condition-based LIMDU significantly decreased average days assigned on LIMDU by 33%. In fact, there is a 35-day (5-week) difference before we can confidently say that the difference between FY21 and FY22 is no longer statistically significant. This significant decrease in LIMDU days, before and after implementation, is a trend consistent at both medical and non-medical NMFL centers; however, medical centers reported significantly more assigned LIMDU days for both years. The five most common injuries of FY21 and FY22 were low back pain, pain in shoulder, pain in hip, pain in knee, and pain in ankle. Before implementation, all five of these injury types far exceeded the recommended amount of LIMDU days. With the new condition-based LIMDU paradigm, the average assigned LIMDU days for pain in hip, pain in knee, and pain in ankle were all found to be in compliance with the recommended LIMDU days within a 99% confidence level. The new condition-based LIMDU paradigm is successful in its aim to improve fleet readiness by returning Sailors and Marines to full duty status significantly faster. Regular assessment of ICD-10 diagnosis codes and update to recommended LIMDU assignment timelines should be conducted to maximize the effectiveness and accuracy for all medical conditions.

(404) National Trends of Penile Fracture Encounters 2016-2019

Abstract Introduction Penile Fracture (PF) is an acute urological emergency resulting from the rupture of the tunica albuginea and one or both of the corpus cavernosa. Immediate surgical intervention is crucial in avoiding long-term complications, however the epidemiology and treatment patterns remain understudied, especially with the introduction of the 10th Revision of the International Classification of Diseases (ICD-10). Objective To evaluate national trends of PF encounters as well as predictive factors of inpatient admission from the emergency department (ED). Methods All patients admitted to the ED for PF between 2016-2019 were extracted from the NEDS using the ICD-10 Diagnosis Code S39.840 and its modifiers. Multivariable logistic regression was performed to identify predictors of this inpatient admission. Results Between 2016-2019, there were an estimated 7,091 weighted encounters related to PF in the US with an overall 13% increase in cases (Figure 1). About 20.8% (1,477) of these encounters led to inpatient admission. The average age of a patient presenting with PF was 41 years old. The majority of encounters took place in the South (44.12%) at non-trauma center rural hospitals (63.99%) and involved private insurance holders (44.42%). For those admitted to inpatient service, the average length of stay was 1.44 days, with a maximum of 26 days. The average total charge for patients discharged from the ED was $11,224 USD and those admitted were faced with charges averaging $33,474 USD. Predictors of inpatient admission included an Elixhauser Comorbidity Score > 1, encounters in the Northeast, Midwest, and Western states, and being covered by Medicaid (p < .05). Conclusions Penile fractures have seen a small increase in incidence from 2016-2019. Although inpatient admissions are less common, they carry significantly higher costs. Further studies of treatments and regional analysis may be warranted to decrease the amount of inpatient admissions. Disclosure No.

Risk of mortality in older adults with loss of appetite: An analysis of Medicare fee-for-service data

ObjectivesPrior research suggested that loss of appetite (LOA) among adults with Medicare fee-for-service (FFS) insurance in the United States increased the risk of mortality within 1 year; those findings were not adjusted for risk factors and confounders. The objective of this study was to compare the risk of mortality among Medicare FFS beneficiaries with LOA to a control group without LOA while controlling or adjusting for age, comorbidities, body mass index (BMI), and weight loss. DesignRetrospective and observational analysis of Medicare FFS health insurance claims data from October 1, 2015 to December 31, 2021. SettingClaims from all settings (e.g., hospital inpatient/outpatient, office, assisted living facility, skilled nursing facility, hospice, rehabilitation facility, home) were included in these analyses. ParticipantsThe LOA group included all individuals aged 65–115 years with continuous Medicare FFS medical coverage (Parts A and/or B) for at least 12 months before a claim with ICD-10 diagnosis code “R63.0 Anorexia”. The control group was drawn from individuals aged 65–115 years with continuous Medicare FFS coverage who did not have a diagnosis of R63.0. Individuals with LOA were matched 1:3 to those in the control group based on age, sex, and race/ethnicity. MeasurementsMortality in the LOA group was compared to mortality in the control group using Kaplan–Meier and Cox regression analyses and stratified or adjusted in terms of Charlson Comorbidity Index (CCI), claims-based frailty index (CFI), BMI, and weight loss. ResultsThe study population of 1,707,031 individuals with LOA and 5,121,093 controls without LOA was 61.7% female and 82.2% White. More individuals with LOA compared with the control group had a CCI score 5+ (52.4% vs. 19.4%), CFI score 5+ (31.6% vs. 6.4%), and BMI < 20 kg/m2 (11.2% vs. 2.1%). Median follow-up was 12 months (individuals with LOA) and 49 months (control group). In a matched population, the risk of mortality was significantly higher (unadjusted hazard ratio 4.40, 95% confidence interval 4.39–4.42) for individuals with LOA than the control group. Median survival time was 4 months (individuals with LOA) and 26 months (control group); differences in survival time remained when stratifying by CCI, BMI, and weight loss. ConclusionIndividuals with LOA had a substantially increased risk of death even after matching for age, sex, race/ethnicity, and adjusting for comorbidities. These findings highlight the burden of illness in older adults with LOA and the need for therapies.

Abstract TP107: Quantifying Hospital Opportunities to Increase Thrombolysis

Introduction: Emergency-department-based implementation strategies to increase thrombolysis are promising. We sought to quantify the number of hospitals with opportunities to increase thrombolysis under various tPA treatment thresholds. Methods: We used data from the 2018 State Inpatient Databases (SID) from 17 states. The study population was limited to ischemic stroke patients admitted to the hospital. The primary outcome was the sum of patients receiving stroke thrombolysis (tPA) at each facility (DRG 61-63, ICD-10 procedure code 3E03317, ICD-10 diagnosis code Z92.82). The primary exposure was hospital stroke volume categorized into quartiles (1 st Quartile [Low]: 1-7, 2 nd Quartile: 8-53, 3 rd Quartile: 54-178, 4 th Quartile [High]: 179-1431). To estimate the number of additional patients treated if hospitals improve their thrombolysis rates across various thresholds, we calculated the expected number of thrombolysis treatments (tPA thresholds multiplied by hospital stroke volume and subtracted by the number of patients receiving tPA at each facility). Results: We identified 203,843 hospital admissions with a primary ischemic stroke diagnosis from 1608 hospitals. On average, 13.3% of patients received tPA. The proportion of stroke patients receiving tPA was higher in higher stroke volume hospitals (Table 1). Black people were more likely to receive care at high-stroke volume hospitals. Among 1608 hospitals, 1131 (70%) had tPA rates below 10%. If these 1131 hospitals improve their tPA rates to 10%, 2655 (2.3 patients/hospital/year) additional stroke patients would be treated with tPA. Conclusions: Low stroke volume hospitals have the lowest thrombolytic treatment rates, but interventions at these hospitals will have limited population benefits and may not be an efficient use of hospital resources. Intervening at high-volume, low-performing hospitals offers the largest opportunity to increase thrombolysis and will promote stroke racial equity.

Prevalence of pediatric lower urinary tract symptoms in a national claims database of privately insured patients, 2003-2014.

We conducted this study to estimate the prevalence of pediatric lower urinary tract symptoms (pLUTS) in a US privately insured pediatric population who are 6-20 years old by age, sex, race/ethnicity from 2003-2014. This has not been previously described in the literature. We retrospectively reviewed Optum's de-identified Clinformatics® Data Mart Database between 2003-2014. A pLUTS patient was defined by the presence of ≥ 1 pLUTS-related ICD-9 diagnosis code between the age of 6-20 years. Neurogenic bladder, renal transplant and structural urologic disease diagnoses were excluded. Prevalence by year was calculated as a proportion of pLUTS patients among the total population at risk. Variables reviewed included age, sex, race, geographic region, household factors and clinical comorbidities including attention-deficit/hyperactivity disorder (ADHD), constipation, and sleep apnea. Point of service (POS) was calculated as a proportion of pLUTS-related claims associated with a POS compared to the total claims at all POS in the time period. We identified 282,427 unique patients with ≥ 1 claim for pLUTS between the ages of 6-20 years from 2003 to 2014. Average prevalence during this period was 0.92%, increasing from 0.63% in 2003 to 1.13% in 2014. The median age group of patients was 6-10 years. More patients were female (59.80%), white (65.97%), between 6 and 10 years old (52.18%) and resided in the Southern US (44.97%). Within a single household, 81.71% reported ≤ 2 children, and 65.53% reported ≥ 3 adults. 16.88% had a diagnosis of ADHD, 19.49% had a diagnosis of constipation and 3.04% had a diagnosis of sleep apnea. 75% of pLUTS-related claims were recorded in an outpatient setting. Families consistently seek medical care in the outpatient setting for pLUTS. The demographic and clinical characteristics of our cohort reflect prior literature. Future studies can help define temporal relationships between household factors and onset of disease as well as characterize pLUTS-related healthcare resource utilization. Additional work is required in publicly insured populations.

DEVELOPMENT OF CROHN'S DISEASE IN PATIENT PRESENTING WITH COMPLEX PERIANAL FISTULA TO A TERTIARY MEDICAL CARE CENTER

Abstract BACKGROUND Approximately 20% of patients with Crohn’s disease (CD) will develop a perianal fistula (PAF), most of which are complex fistulas1-4. Studies have shown that 4-5% of patients with CD present with perianal fistula without luminal disease, termed isolated perianal Crohn’s disease4,5,6. However, little is known about the natural history of isolated complex PAF (iPAF). We therefore aimed to evaluate the clinical course of patients who presented with iPAF including describing those who subsequently developed luminal CD. METHODS We performed a retrospective cohort study of patients seen within the Mount Sinai Health System (New York) with an ICD-10 diagnosis code for PAF between 7/22/2008 and 7/22/2022. Medical record review was conducted to identify patients with complex PAF who did not have evidence of luminal disease and had &amp;gt; 6 months of follow-up (Table 1). Luminal disease was defined as any evidence of ulcers, erosions, or strictures on endoscopic or video capsule exam or MRE with evidence of inflammation consistent with luminal CD. Demographics, comorbidities, imaging, endoscopy, surgeries, hospitalizations and medication data were collected. Descriptive and univariate analyses were performed. Complicated disease course was defined as a composite of any major CD-related surgery, PAF/IBD-related hospitalization or biologic use. RESULTS Among 887 patients with PAF, 62.2% (n=552) patients underwent luminal evaluation, of whom 80 patients (14.5%) were found to have no luminal disease (Table 1). Of these, 57 patients had &amp;gt;6 months of follow-up with 22.8% (n=13) going on to develop luminal disease. Luminal CD was diagnosed at a mean time of 4.2 (SD=3.8) years after iPAF presentation. Compared to patients who developed luminal CD, patients with solely iPAF were less likely to be &amp;lt;30 years old at PAF diagnosis (p=0.0225) or have concomitant autoimmune conditions (p=0.046) (Table 2). Patients with iPAF were less likely to have &amp;gt;2 fistulas (p=0.002) or have CD/PAF-related hospitalization (29.5% vs 61.5%, p =0.0356) compared to those who developed luminal CD (Table 2). Patients with iPAF were significantly less likely to have a complicated disease course than those who later developed luminal CD (2.3% vs 30.8%, p=0.007). CONCLUSION We observed that approximately 1 in 4 patients who presented with iPAF went on to develop luminal CD. Patients who went on to develop luminal CD were more likely to be &amp;lt;30 at PAF diagnosis, have concomitant autoimmune conditions and were more likely to have IBD-related adverse outcomes. The majority of patients with iPAF did not experience a complicated disease course and may represent a specific sub-phenotype of CD.

P986 Effectiveness of the adjuvanted recombinant zoster vaccine (RZV) in preventing herpes zoster (HZ) among patients ≥50 years of age with Inflammatory Bowel Disease in the United States: A retrospective real-world database analysis from 2018 to 2021

Abstract Background Patients with inflammatory bowel disease (IBD) are at higher risk of developing HZ compared to general population.1 The US Food and Drug Administration (FDA) approved RZV for adults ≥50 years of age (YOA) in Oct 2017 and for adults ≥18 YOA who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression, as patients with IBD, in Jul 2021. This study addresses an information gap for RZV vaccine effectiveness (VE) in preventing HZ among IBD patients ≥50 YOA. Methods We conducted a retrospective matched cohort study using the Optum Clinformatics Data Mart healthcare administrative claims database from Jan 2018 to Dec 2021. Patients ≥50 YOA with IBD who received 2 RZV doses with dose interval ≥28 days (RZV [2-dose] cohort) were 1:3 matched to their unvaccinated counterparts (non-RZV cohort) by age, medication category, and other confounders (propensity score). The index date for RZV cohort was the date of the second dose and for non-RZV cohort was the same index date as their vaccinated match. Follow-up started from index date +30 days until earliest date of HZ occurrence, end of enrolment, death, receipt of HZ vaccine, or study end. The first HZ episode during follow-up was identified using an algorithm that included ICD-10 diagnosis code, inpatient or outpatient claims and/or HZ antiviral medication used within 7 days pre/post-HZ diagnosis. Incidence rates (IRs) of HZ were calculated overall, stratified by condition (ulcerative colitis [UC], Crohn’s disease [CD]) and age. Cox hazards models were used to estimate overall and stratified hazard ratios (HRs). VE (%) was calculated as (1−HR) × 100. A similar approach was used to evaluate VE for patients who received 1 RZV dose. Results We identified 6501 RZV vaccinated and 19962 matched unvaccinated IBD patients who were included in the 2-dose analysis (Table). The IR of HZ was 2.92/1000 person-years (PY) in the RZV cohort and 10.96/1000 PY in the non-RZV cohort, resulting in a VE of 73.4% (95% confidence intervals [CIs]: 60.8-82.0) for IBD patients (Figure). VE against HZ was 63.5% (95%CIs: 43.0-76.6) and 85.7% (95%CIs: 69.5-93.3) in UC and CD 2-dose cohorts. IRs and VE stratified by condition and age are presented in Figure. Adjusted VE for IBD patients who received 1 RZV dose was 63.4% (95%CIs: 24.9-82.2). Conclusion Our analysis provides real-world evidence that RZV vaccination is effective in preventing HZ in IBD patients ≥50 YOA and reduce the burden in this population with increased risk of HZ. These findings are consistent with the available literature on RZV effectiveness in patients with IBD, suggesting that this population could greatly benefit from RZV vaccination. 1. Yun H et al, Arthritis Rheumatol 2016;68:2328-37 Funding GSK

DOP68 Natural history of isolated Crohn's Disease perianal fistula

Abstract Background Approximately 20% of patients with Crohn’s disease (CD) have perianal fistulizing CD, which are most often complex PAF. Studies have shown that 4-5% of patients with CD present with PAF without luminal disease, termed isolated perianal CD (iPCD). Little is known about their natural history. Methods We performed a retrospective cohort study of patients seen within the Mount Sinai Health System (New York) with an ICD-10 diagnosis code for PAF between 7/22/2008 and 7/22/2022. Medical record review was conducted to identify patients with PAF, considered as possible iPCD, who did not have evidence of luminal disease and had &amp;gt; 6 months of follow-up (Table 1). Demographics, comorbidities, imaging, endoscopy, surgeries, hospitalizations and medication data were collected. These patients were reviewed to determine progression to luminal disease, which was defined as any evidence of luminal ulcers, erosions, or strictures on endoscopy, histology, video capsule exam, or MRE. Descriptive and univariate analyses were performed. Complex PAF was defined by American Gastroenterological Association criteria. Complicated disease course was defined as a composite of any major CD-related surgery, PAF/IBD-related hospitalization or biologic use. Results Among 887 patients who presented with PAF, 62.2% (n=552) patients underwent luminal evaluation, of whom 80 patients (14.5%) were found to have no luminal disease and considered as having iPCD (Table 1). 57 of these 80 patients had &amp;gt;6 months follow-up. Luminal disease developed in 13 patients (23%) with a mean time to diagnosis of 4.2 +/- 3.8 years after PAF presentation. Patients who developed luminal CD were more likely to be &amp;lt;30 years old at PAF diagnosis (p=0.0225), had &amp;gt;2 fistulas on imaging (p=0.002), and have concomitant autoimmune conditions (p=0.046) (Table 2). During the follow-up period, the patients who developed luminal CD were more likely to receive biological therapy (77% vs 16%, p&amp;lt;0.0001) or undergo CD/PAF-related hospitalization (62% vs 30%, p =0.0356) (Table 2). Overall, patients who developed luminal CD had a more complicated disease course (31% vs 2.3%, p=0.007) than those who did not. Conclusion Approximately 1 in 4 patients who presented with possible iPCD developed luminal CD at follow-up. Patients who developed luminal CD were more likely to be younger at diagnosis, had more fistula tracts, and had concomitant autoimmune conditions.

Validation of the Diagnostic Accuracy Levels of International Classification of Diseases, 10th Revision Codes for Diabetic Ketoacidosis: A Multicentre, Cross-sectional Study of Adults

ObjectivesInternational Classification of Diseases (ICD) codes are commonly used to identify cases of diabetic ketoacidosis (DKA) in health services research, but they have not been validated. Our aim in this study was to assess the accuracy of ICD, 10th revision (ICD-10) diagnosis codes for DKA. MethodsWe conducted a multicentre, cross-sectional study using data from 5 hospitals in Ontario, Canada. Each hospitalization event has a single most responsible diagnosis code. We identified all hospitalizations assigned diagnosis codes for DKA. A true case of DKA was defined using laboratory values (serum bicarbonate ≤18 mmol/L, arterial pH ≤7.3, anion gap ≥14 mEq/L, and presence of ketones in urine or blood). Chart review was conducted to validate DKA if laboratory values were missing or the diagnosis of DKA was unclear. Outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-10 codes in patients with laboratory-defined DKA. ResultsWe identified 316,517 hospitalizations. Among these, 312,948 did not have an ICD-10 diagnosis code for DKA and 3,569 had an ICD-10 diagnosis code for DKA. Using a combination of laboratory and chart review, we identified that the overall PPV was 67.0%, the NPV was 99.7%, specificity was 99.6%, and sensitivity was 74.9%. When we restricted our analysis to hospitalizations in which DKA was the most responsible discharge diagnosis (n=3,374 [94.5%]), the test characteristics were PPV 69.8%, NPV 99.7%, specificity 99.7%, and sensitivity 71.9%. ConclusionICD-10 codes can identify patients with DKA among those admitted to general internal medicine.

Trends, demographics and reoperation rates of periacetabular osteotomy: an analysis from the PearlDiver database.

This study aims to examine the trends and demographics of periacetabular osteotomy (PAO) in the United States from 2016 to 2020 using a large healthcare database analysis. The PearlDiver database was queried for patients who underwent a PAO procedure starting with current procedural terminology (CPT) codes 27299, S2115 and 27146. Subsequently, the population was filtered for patients being ages 12-50, having an inpatient charge-type and those having a length of stay of at least 1 day. Patients with total hip arthroplasty were filtered out, and the resulting population was filtered by ICD-10 diagnosis codes. The providers of each patient were also examined to ensure their history of treating hip dysplasia. Student t and multiple regression analysis tests were used for statistical comparisons and trends analysis (P < 0.05 reported as significant). A total of 535 consecutive patients were analyzed over the study period. There was a higher incidence of PAO in females compared with males (P < 0.001) and a higher incidence of PAO in patients aged 15-19 years compared with older age groups (P = 0.017). Within the first year after the index PAO, 171 of the 535 patients, almost one-third (32%), received a reoperation. Of the 171 reoperations, 115 were deep removal of implant, 55 were a hip arthroscopy and 1 patient had a bone excision for heterotopic ossification. Similar studies should be carried out using other large health databases to confirm the external validity of these trends and rates across the United States.

Comparison of two testing strategies for Mycoplasma genitalium in emergency department patients across a statewide health system

PurposeMycoplasma genitalium (Mgen) is a sexually transmitted infection (STI) that has an estimated prevalence in the general population of 2.3% in women and 1.1% in men aged 21–23 years. (Hilbert and Reno, 2018) A cross-sectional study conducted in a community emergency department (ED) determined that the prevalence of Mgen was 14.8% in asymptomatic female patients. (Centers for Disease Control and Prevention (CDC). Sexually Transmitted Infections Treatment Guidelines, 2021) The Centers for Disease Control and Prevention (CDC) 2021 STI Treatment Guidelines recommend testing for Mgen in select circumstances. This study aims to determine what testing strategy in ED patients results in the most appropriate treatment of Mgen based on CDC recommendations. MethodsThis multicenter, retrospective, pre- and post-intervention cohort study assessed adherence to CDC recommendations for appropriate management of Mgen in ED patients. Inclusion criteria were patients at least 18 years of age discharged from one of the 15 ED sites within the health system studied who were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis (T. vaginalis), and Mgen. Subjects were excluded if they were pregnant, sexually assaulted, or had indeterminate STI results. For cohort 1, which included patients evaluated from May 2022 through July 2022, Mgen was incorporated into the standard STI testing panel. Cohort 2 consisted of patients evaluated from September 2022 through November 2022; testing for Mgen in cohort 2 was optional, and a testing algorithm based on CDC recommendations was disseminated to ED sites. The primary endpoint was the number of subjects treated appropriately for Mgen in accordance with CDC recommendations. Cohort 1 secondary endpoints included overall prevalence of Mgen in patients who presented to ED sites for STI testing and prevalence in ICD-10 code diagnosed PID. Secondary endpoints for both cohorts included baseline characteristics of patients who tested positive for Mgen. ResultsPercent appropriate treatment did not differ significantly between cohort 1 (21%) and cohort 2 (20%), (p > 0.9). However, greater than three times as many subjects were inappropriately treated for Mgen in cohort 1 when the health system studied did not adhere to current CDC Mgen testing recommendations. The overall prevalence of Mgen in ED patients who were tested for STIs was 13.1%. The prevalence of PID ICD-10 diagnosis code in patients positive for Mgen was 2.9%. Based on results of a risk factor analysis to determine if certain baseline characteristics are indicators for a positive infection with Mgen, a positive Mgen result was significantly associated with a positive result for T. vaginalis (p = 0.042). ConclusionsEvidence regarding the preferred testing strategy for Mgen is currently limited. This study demonstrates that testing all STI presenting patients for Mgen results in antibiotic overuse, so adhering to CDC testing recommendations is important. Prevalence of positive Mgen result in ED patients tested for STIs was similar to results of previously published literature. Risk factor analysis results could be used as a screening method to determine what patients should be considered for Mgen testing. Based on the results of this study, we recommend against including Mgen on the standard ED STI testing panel at this time.

Assessing the effect of selective serotonin reuptake inhibitors in the prevention of post-acute sequelae of COVID-19

BackgroundPost-acute sequelae of COVID-19 (PASC) produce significant morbidity, prompting evaluation of interventions that might lower risk. Selective serotonin reuptake inhibitors (SSRIs) potentially could modulate risk of PASC via their central, hypothesized immunomodulatory, and/or antiplatelet properties although clinical trial data are lacking. Materials and MethodsThis retrospective study was conducted leveraging real-world clinical data within the National COVID Cohort Collaborative (N3C) to evaluate whether SSRIs with agonist activity at the sigma-1 receptor (S1R) lower the risk of PASC, since agonism at this receptor may serve as a mechanism by which SSRIs attenuate an inflammatory response. Additionally, determine whether the potential benefit could be traced to S1R agonism. Presumed PASC was defined based on a computable PASC phenotype trained on the U09.9 ICD-10 diagnosis code. ResultsOf the 17,908 patients identified, 1521 were exposed at baseline to a S1R agonist SSRI, 1803 to a non-S1R agonist SSRI, and 14,584 to neither. Using inverse probability weighting and Poisson regression, relative risk (RR) of PASC was assessed.A 29% reduction in the RR of PASC (0.704 [95% CI, 0.58–0.85]; P = 4 ×10−4) was seen among patients who received an S1R agonist SSRI compared to SSRI unexposed patients and a 21% reduction in the RR of PASC was seen among those receiving an SSRI without S1R agonist activity (0.79 [95% CI, 0.67 - 0.93]; P = 0.005).Thus, SSRIs with and without reported agonist activity at the S1R were associated with a significant decrease in the risk of PASC.

Reverse total shoulder arthroplasty for proximal humerus fracture: a complex episode of care associated with increased surgical and medical complications

IntroductionReverse total shoulder arthroplasty (rTSA) remains a viable treatment option in elderly patients with proximal humerus fractures (PHF). However, the risk profile of this procedure in this patient population has not been well established by prior studies. The aim of this study is to examine whether there are differences in sociodemographic variables, underlying medical comorbidities, and 90-day outcomes between patients undergoing rTSA for osteoarthritis (OA) vs. PHF. We hypothesized that patients with PHF would be older and have higher comorbidity burden compared to glenohumeral OA controls. Furthermore, we hypothesized that rTSA would yield inferior outcomes and higher costs of care in patients with PHF compared to glenohumeral OA. MethodsPatients who underwent primary rTSA from 2016 to 2020 were identified in the Premier Healthcare Database. PHF patients were identified using the International Classification of Diseases, Tenth Revision diagnosis codes and compared to OA controls. All patients < 18 years old and those who underwent rTSA for other indications were excluded. Patients were matched in a 2:1 fashion based on age (± 3 years), sex, race, and presence of pertinent comorbidities. Patient demographics, hospital factors, comorbidities and 90-day surgical (wound complications, dislocation, periprosthetic fracture, periprosthetic joint infection, stiffness, loosening, mechanical complications, and revision) and medical (deep vein thrombosis/pulmonary embolism, pneumonia, respiratory failure, renal failure, stroke, myocardial infarction, and sepsis) complications and readmission were compared between the two cohorts. Descriptive statistics and regression analysis were employed with significance set at P < .05. Odds ratio (OR) and 95% confidence interval were calculated. ResultsBefore matching 51,150 OA controls and 11,394 PHF cases were identified. After matching, 8661 PHF cases were matched to 17,332 controls. Regarding surgical complications, PHF patients were at significantly increased risk of periprosthetic fracture (OR 2.35), dislocation (OR 2.87), superficial wound infection (OR 5.51), periprosthetic joint infection (OR 1.91) and 90-day revision (OR 4.76). PHF patients were at increased risk of all medical complications examined including hemorrhage (OR 2.20), anemia (OR 2.78) deep vein thrombosis (OR 3.10), pulmonary embolism (OR 2.83), pneumonia (OR 2.93), respiratory failure (OR 3.37), pneumonia (OR 2.93), stroke (OR 2.61), myocardial infarction (OR 2.79), acute renal failure (OR 4.06), urinary tract infection (OR 5.50) and sepsis (OR 3.71) as well as 90-day readmission (OR 2.13). Discussion/ConclusionPatients undergoing rTSA for PHF are at significantly increased risk of complications compared to OA controls. Furthermore, these patients are at increased risk of 90-day readmission. These findings should prompt diligent preoperative risk stratification by surgeons and healthcare providers to prevent patient morbidity.

French National Trends in Neurodevelopmental and Mental Health-Related Healthcare Center Visits among Youth, 2014-2022: Towards Sex Specificities in the Care Pathway

Background: Neurodevelopmental disorders (NDD) and mental health (MH)-related conditions among children and adolescents, represent a global public health burden, that was worsened by the COVID-19 pandemic due to disruptions in access to healthcare, support services, and increased stressors exacerbating symptoms and challenges. However, few studies have examined in France, NDD and MH’s diagnoses and care pathway in youth attending public healthcare center (HCC) services. Methods: An annual cross-sectional analysis was performed in youth aged 0 to 17 years on health information, that were extracted from the French PMSI database (DIAMANT database) between January 1, 2014, and December 31, 2022, using the MH-related ICD-10 diagnosis codes, including NDD, mood-, behavior-, anxiety-, and other-disorders (sleep and eating). Trends in healthcare center visits for NDD and MH-related conditions, were evaluated according to age, sex, diagnoses, and care pathway over the 10-year period using ANOVAs. Findings: Out of the 17,707,806 total HCC-visits across a 10-year period, 289,382 visits (1,6%) were related to youth with diagnoses for NDD or MH disorders of the study interest. Among them, 57% were girls and 43% boys. The total number of pediatric HCC-visits related to NDD and MH has remained stable from 2014 to 2022. However, the proportion of visits has doubled for adolescent girls with internalizing disorders (anxiety and mood) while a 5-fold decrease in the proportion of visits for NDD, was observed for boys aged 0 to 12 years. The HCC-admission mainstream for internalizing disorders was the emergency department and was “home” for the NDD. While the HCC-discharge accounted for 9% of patients being hospitalized, most of them were sent home (90.7%) with a strong age- and sex-specificities. Interpretation: Over the last 10 years, the proportion of HCC visits for NDD and MH remained stable, but strong age- and sex-effects were found on diagnoses visits and care pathway. These findings are essential to improve emergency and outpatient service capacity dedicated to youth. They could help European and national policies to patient-tailor care pathway depending on sex and diagnosis from screening, interventions, and monitoring during this sensitive period of development.

Admission Rates, Healthcare Utilization, and Inpatient Cost of Radiation Cystitis in the United States

To assess the incidence, cumulative healthcare burden, and financial impact of inpatient admissions for radiation cystitis (RC), while exploring practice differences in RC management between teaching and nonteaching hospitals. We focused on 19,613 patients with a diagnosis of RC within the National Inpatient Sample (NIS) from 2008 to 2014. ICD-9 diagnosis and procedure codes were used. Complex-survey procedures were used to study the descriptive characteristics of RC patients and the procedures received during admission, stratified by hospital teaching status. Inflation-adjusted cost and cumulative annual cost were calculated for the study period. Multivariable logistic regression was used to study the impact of teaching status on the high total cost of admission. Median age was 76 (interquartile range 67-82) years. Most of the patients were males (73%; P<.001). 59,571 (61%) patients received at least one procedure, of which, 24,816 (25.5%) received more than one procedure. Median length of stay was 5days (interquartile range 2-9). Female patients and patients with a higher comorbidity score were more frequently treated at teaching hospitals. A higher proportion of patients received a procedure at a teaching hospital (64% vs 59%; P<.001). The inflation-adjusted cost was 9207 USD and was higher in teaching hospitals. The cumulative cost of inpatient treatment of RC was 63.5 million USD per year and 952.2 million USD over the study period. The incidence of RC-associated admissions is rising in the US. This disease is a major burden to US healthcare. The awareness of the inpatient economic burden and healthcare utilization associated with RC may have funding implications.

Building a Cohort of Transgender and Nonbinary Patients from the Electronic Medical Record.

Purpose: Sexual orientation, gender identity, and sex recorded at birth (SOGI) have been routinely excluded from demographic data collection tools, including in electronic medical record (EMR) systems. We assessed the ability of adding structured SOGI data capture to improve identification of transgender and nonbinary (TGNB) patients compared to using only International Classification of Diseases (ICD) codes and text mining and comment on the ethics of these cohort formation methods. Methods: We conducted a retrospective chart review to classify patient gender at a single institution using ICD-10 codes, structured SOGI data, and text mining for patients presenting for care between March 2019 and February 2021. We report each method's overall and segmental positive predictive value (PPV). Results: We queried 1,530,154 EMRs from our institution. Overall, 154,712 contained relevant ICD-10 diagnosis codes, SOGI data fields, or text mining terms; 2964 were manually reviewed. This multipronged approach identified a final 1685 TGNB patient cohort. The initial PPV was 56.8%, with ICD-10 codes, SOGI data, and text mining having PPV of 99.2%, 47.9%, and 62.2%, respectively. Conclusion: This is one of the first studies to use a combination of structured data capture with keyword terms and ICD codes to identify TGNB patients. Our approach revealed that although structured SOGI documentation was <10% in our health system, 1343/1685 (79.7%) of TGNB patients were identified using this method. We recommend that health systems promote patient EMR documentation of SOGI to improve health and wellness among TGNB populations, while centering patient privacy.

Hepatitis A hospitalisations in the United States and risk factors for inpatient mortality: A nationwide population study, 1998-2020.

Hepatitis A virus infections in the United States have been declining; however, recent widespread outbreaks have brought the disease back into the spotlight. We aim to describe the epidemiology of hepatitis A hospitalisations from 1998 to 2020 in the United States and investigate risk factors for inpatient mortality. We utilised the National Inpatient Sample database and identified hepatitis A-related hospitalisations using ICD-9 and ICD-10 diagnosis codes. Demographic and clinical data including death, coinfections, comorbidities and pregnancy status were extracted. Data were analysed by logistic and Poisson regression. We identified a total of 213,681 hepatitis A-related hospitalisations between 1998 and 2020, with hospitalisation rates ranging between 22.4 per 1,000,000 and 62.9 per 1,000,000. Between 1998 and 2015, the hospitalisation rate for hepatitis A was decreasing (IRR = 0.98; 95% CI: 0.97-0.98; p < .001); however, between 2015 and 2020, it increased overall (IRR = 1.22; 95% CI: 1.21-1.23; p < .001). The overall inpatient mortality rate was 2.7%. Age ≥55 years (OR = 1.84; 95% CI: 1.41-2.40; p < .001), alcoholic cirrhosis (OR = 2.53; 95% CI: 1.64-3.90; p < .001), ascites (OR = 2.65; 95% CI: 1.86-3.78; p < .001), hepatorenal syndrome (OR = 9.04; 95% CI: 5.93-13.80; p < .001), heart failure (OR = 1.76; 95% CI: 1.29-2.39; p < .001), pulmonary hypertension (OR = 2.02; 95% CI: 1.28-3.19; p = .003) and malignant neoplasm (OR = 1.75; 95% CI: 1.25-2.45; p = .001) were associated with increased odds of mortality. Tobacco use disorder (OR = 0.52; 95% CI: 0.38-0.70; p < .001) was associated with decreased odds of mortality. None of the hepatitis A-associated hospitalisations involving pregnant women resulted in death. Hepatitis A hospitalisations initially declined but increased rapidly after 2015. Certain risk factors can be used to predict prognosis of hospitalised patients.

Castleman disease- demographics, associations, and outcomes: an analysis of adult 791 cases.

Castleman disease (CD), also known as angiofollicular lymph node hyperplasia or large lymph node hyperplasia, is a rare medical condition. Despite its rarity, it exhibits diverse clinical presentations and outcomes, which pose challenges for comprehensive understanding and management. This study aims to shed light on the demographics, associations, and outcomes of CD by conducting a retrospective analysis. The National Inpatient Sample (US) was used to identify patients with the diagnosis of Castleman disease using ICD-10 diagnosis code D47.Z2, during the years 2016-2019. Data was collected on demographics, associated diagnoses, treatments and outcomes. Data analysis was performed using STATA Version 17, College Station, TX: Stata Corp LLC. Our study identified 791 hospitalizations involving adult CD patients. The mean age of these patients was 52.4 years, with a male predominance (56.1%). Whites comprised the largest racial group affected (50.1%). Most patients were covered by Medicare (39.6%). The majority received treatment in urban teaching hospitals (84.0%) and large-bed size facilities (62.5%). In-hospital mortality was low at 2.8%, with an average length of stay of 7.5 days and average total charges of $109,308. Common associations included acute kidney injury (27.0%), congestive heart failure (17.1%), sepsis (16.4%), and acute respiratory failure (12.6%). Hematological and lymphatic associations featured anemia (47.5%), thrombocytopenia (12.2%), and other conditions. Red blood cell transfusions were administered to 11.1% of patients. This study contributes valuable insights into CD, a rare and clinically heterogeneous disease. It underscores the importance of recognizing its associations and complications. Additionally, it highlights the need for further research and improved diagnostic and treatment guidelines to address the complexity of this condition.

Occurrence of sleep disorders, anxiety, and depression among patients with mild cognitive impairment and Alzheimer’s disease in diverse populations: A large nationwide electronic health record cohort study

AbstractBackgroundPatients affected with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) often experience anxiety, depression, and sleep disturbances. Some of the published studies reported a higher incidence of these disorders in minority populations. The objectives of this study were to characterize the occurrence of sleep disorders, anxiety, and depression among patients with MCI and/or AD, stratified by gender, age and race/ethnicity in the United States clinical practice setting.MethodA retrospective cohort study was conducted using electronic health records and insurance claims from the Optum® Market Clarity database containing data from more than 63 million people in the US insured through Medicare, Medicaid, and other insurance providers. The study included patients diagnosed, utilizing ICD diagnosis codes, with MCI and/or AD between January 2017 and September 2021. Prevalence of depression, anxiety, and sleep disorders, as well as associated medication prescriptions, were identified in the 12 months before and after MCI and/or AD diagnoses. The occurrence of these diagnoses and prescriptions was evaluated stratified by gender, age, and race/ethnicity.ResultA total of 197,346 patients were diagnosed with MCI (56.9% female, mean age of 70.0 [SD 14.8]) and 144,321 with AD (63.9% female, mean age of 79.3 [SD 8.2]) at the baseline. Overall, a large proportion of MCI and AD cases had depression (pre‐MCI diagnosis: 40.3%; post‐MCI diagnosis: 44.8%; pre‐AD diagnosis: 32.2%; post‐AD diagnosis: 38.3%), anxiety (pre‐MCI diagnosis: 36.2%; post‐MCI diagnosis: 40.2%; pre‐AD diagnosis: 26.4%; post‐AD diagnosis: 31.5%), and sleep disorders (pre‐MCI diagnosis: 36.2%; post‐MCI diagnosis: 39.3%; pre‐AD diagnosis: 23.2%; post‐AD diagnosis: 25.4%). Occurrences of depression and anxiety were highest among females. Among individuals with MCI and/or AD, the gap between the proportion experiencing depression and the proportion prescribed an antidepressant was greatest for African American males and females. This was not observed for anxiety and anti‐anxiety medications.ConclusionA large proportion of individuals with MCI and/or AD also had depression, anxiety, and sleep issues. Further understanding of the populations with these comorbidities and their associated prescriptions by different ages, sex, and races/ethnicities is important when supporting patients with MCI and AD.