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Defining emergency department asthma visits for public health surveillance, North Carolina, 2008-2009.

Travers D, Lich KH, Lippmann SJ, Weinberger M, Yeatts KB, Liao W, Waller A - Prev Chronic Dis (2014)

Bottom Line: The study was a cross-sectional analysis of population-level ED surveillance data.Of the 114 North Carolina EDs eligible to participate in a statewide surveillance system in 2008-2009, we used data from the 111 (97%) that participated during those years.Prevalence ratios compared each category's proportion of visits that received either asthma- or cardiac-related procedure codes.

View Article: PubMed Central - PubMed

Affiliation: CB 7460, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460. E-mail: dtravers@email.unc.edu.

ABSTRACT

Introduction: When using emergency department (ED) data sets for public health surveillance, a standard approach is needed to define visits attributable to asthma. Asthma can be the first (primary) or a subsequent (2nd through 11th) diagnosis. Our study objective was to develop a definition of ED visits attributable to asthma for public health surveillance. We evaluated the effect of including visits with an asthma diagnosis in primary-only versus subsequent positions.

Methods: The study was a cross-sectional analysis of population-level ED surveillance data. Of the 114 North Carolina EDs eligible to participate in a statewide surveillance system in 2008-2009, we used data from the 111 (97%) that participated during those years. Included were all ED visits with an ICD-9-CM diagnosis code for asthma in any diagnosis position (1 through 11). We formed 11 strata based on the diagnosis position of asthma and described common chief complaint and primary diagnosis categories for each. Prevalence ratios compared each category's proportion of visits that received either asthma- or cardiac-related procedure codes.

Results: Respiratory diagnoses were most common in records of ED visits in which asthma was the first or second diagnosis, while primary diagnoses of injury and heart disease were more common when asthma appeared in positions 3-11. Asthma-related chief complaints and procedures were most common when asthma was the first or second diagnosis, whereas cardiac procedures were more common in records with asthma in positions 3-11.

Conclusion: ED visits should be defined as asthma-related when asthma is in the first or second diagnosis position.

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Related in: MedlinePlus

Grouped primary diagnosis by asthma diagnosis position, North Carolina emergency department visits, 2008–09, with an asthma diagnosis in any diagnosis position (child visits, N = 100,886; adult visits, N = 249,403).Diagnosis GroupPosition of Asthma Diagnosis123456–11Children (0–17 y), %Diseases of therespiratory system1004634303135Diseases of the heart012222Abdominal pain023543Injury or poisoning01816131311All other diagnosis clusters03345505049Adults (≥18 y), %Diseases of therespiratory system1003621151413Diseases of the heart07891114Abdominal pain01012121110Injury or poisoning025655All other diagnosis clusters04455585958
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Figure 1: Grouped primary diagnosis by asthma diagnosis position, North Carolina emergency department visits, 2008–09, with an asthma diagnosis in any diagnosis position (child visits, N = 100,886; adult visits, N = 249,403).Diagnosis GroupPosition of Asthma Diagnosis123456–11Children (0–17 y), %Diseases of therespiratory system1004634303135Diseases of the heart012222Abdominal pain023543Injury or poisoning01816131311All other diagnosis clusters03345505049Adults (≥18 y), %Diseases of therespiratory system1003621151413Diseases of the heart07891114Abdominal pain01012121110Injury or poisoning025655All other diagnosis clusters04455585958

Mentions: Grouped diagnoses:Figure 1 illustrates the most frequent primary ICD-9-CM diagnosis groupings by diagnosis position in which the asthma diagnosis first appears. For children, respiratory diagnoses (eg, influenza, pneumonia) are the most common reason for ED visits during which asthma was assigned to the second diagnosis position, whereas other diagnoses are most common for adults with asthma in the second position. For both children and adults, the proportion of respiratory visits gradually drops to positions 3–11. In particular for adults, primary diagnoses of heart disease are more common in records when asthma appears in positions 3–11.


Defining emergency department asthma visits for public health surveillance, North Carolina, 2008-2009.

Travers D, Lich KH, Lippmann SJ, Weinberger M, Yeatts KB, Liao W, Waller A - Prev Chronic Dis (2014)

Grouped primary diagnosis by asthma diagnosis position, North Carolina emergency department visits, 2008–09, with an asthma diagnosis in any diagnosis position (child visits, N = 100,886; adult visits, N = 249,403).Diagnosis GroupPosition of Asthma Diagnosis123456–11Children (0–17 y), %Diseases of therespiratory system1004634303135Diseases of the heart012222Abdominal pain023543Injury or poisoning01816131311All other diagnosis clusters03345505049Adults (≥18 y), %Diseases of therespiratory system1003621151413Diseases of the heart07891114Abdominal pain01012121110Injury or poisoning025655All other diagnosis clusters04455585958
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4060874&req=5

Figure 1: Grouped primary diagnosis by asthma diagnosis position, North Carolina emergency department visits, 2008–09, with an asthma diagnosis in any diagnosis position (child visits, N = 100,886; adult visits, N = 249,403).Diagnosis GroupPosition of Asthma Diagnosis123456–11Children (0–17 y), %Diseases of therespiratory system1004634303135Diseases of the heart012222Abdominal pain023543Injury or poisoning01816131311All other diagnosis clusters03345505049Adults (≥18 y), %Diseases of therespiratory system1003621151413Diseases of the heart07891114Abdominal pain01012121110Injury or poisoning025655All other diagnosis clusters04455585958
Mentions: Grouped diagnoses:Figure 1 illustrates the most frequent primary ICD-9-CM diagnosis groupings by diagnosis position in which the asthma diagnosis first appears. For children, respiratory diagnoses (eg, influenza, pneumonia) are the most common reason for ED visits during which asthma was assigned to the second diagnosis position, whereas other diagnoses are most common for adults with asthma in the second position. For both children and adults, the proportion of respiratory visits gradually drops to positions 3–11. In particular for adults, primary diagnoses of heart disease are more common in records when asthma appears in positions 3–11.

Bottom Line: The study was a cross-sectional analysis of population-level ED surveillance data.Of the 114 North Carolina EDs eligible to participate in a statewide surveillance system in 2008-2009, we used data from the 111 (97%) that participated during those years.Prevalence ratios compared each category's proportion of visits that received either asthma- or cardiac-related procedure codes.

View Article: PubMed Central - PubMed

Affiliation: CB 7460, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460. E-mail: dtravers@email.unc.edu.

ABSTRACT

Introduction: When using emergency department (ED) data sets for public health surveillance, a standard approach is needed to define visits attributable to asthma. Asthma can be the first (primary) or a subsequent (2nd through 11th) diagnosis. Our study objective was to develop a definition of ED visits attributable to asthma for public health surveillance. We evaluated the effect of including visits with an asthma diagnosis in primary-only versus subsequent positions.

Methods: The study was a cross-sectional analysis of population-level ED surveillance data. Of the 114 North Carolina EDs eligible to participate in a statewide surveillance system in 2008-2009, we used data from the 111 (97%) that participated during those years. Included were all ED visits with an ICD-9-CM diagnosis code for asthma in any diagnosis position (1 through 11). We formed 11 strata based on the diagnosis position of asthma and described common chief complaint and primary diagnosis categories for each. Prevalence ratios compared each category's proportion of visits that received either asthma- or cardiac-related procedure codes.

Results: Respiratory diagnoses were most common in records of ED visits in which asthma was the first or second diagnosis, while primary diagnoses of injury and heart disease were more common when asthma appeared in positions 3-11. Asthma-related chief complaints and procedures were most common when asthma was the first or second diagnosis, whereas cardiac procedures were more common in records with asthma in positions 3-11.

Conclusion: ED visits should be defined as asthma-related when asthma is in the first or second diagnosis position.

Show MeSH
Related in: MedlinePlus