A New Diagnosis Grouping System for Child Emergency Department Visits

Authors

  • Evaline A. Alessandrini MD, MSCE,

    1. From the Department of Pediatrics (EAA, ERA) and the Department of Emergency Medicine (EAA), University of Pennsylvania School of Medicine and Emergency Medicine (EAA, ERA), The Children’s Hospital of Philadelphia, PA; the Department of Pediatrics, George Washington University School of Medicine (JMC), and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC; the Department of Medicine, Division of General Internal Medicine (JAS), University of Pennsylvania School of Medicine, Philadelphia, PA; and the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin, Milwaukee, WI; in collaboration with the Pediatric Emergency Care Applied Research Network. Dr. Alessandrini is currently with the Department of Pediatrics, University of Cincinnati College of Medicine, Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
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  • Elizabeth R. Alpern MD, MSCE,

    1. From the Department of Pediatrics (EAA, ERA) and the Department of Emergency Medicine (EAA), University of Pennsylvania School of Medicine and Emergency Medicine (EAA, ERA), The Children’s Hospital of Philadelphia, PA; the Department of Pediatrics, George Washington University School of Medicine (JMC), and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC; the Department of Medicine, Division of General Internal Medicine (JAS), University of Pennsylvania School of Medicine, Philadelphia, PA; and the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin, Milwaukee, WI; in collaboration with the Pediatric Emergency Care Applied Research Network. Dr. Alessandrini is currently with the Department of Pediatrics, University of Cincinnati College of Medicine, Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
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  • James M. Chamberlain MD,

    1. From the Department of Pediatrics (EAA, ERA) and the Department of Emergency Medicine (EAA), University of Pennsylvania School of Medicine and Emergency Medicine (EAA, ERA), The Children’s Hospital of Philadelphia, PA; the Department of Pediatrics, George Washington University School of Medicine (JMC), and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC; the Department of Medicine, Division of General Internal Medicine (JAS), University of Pennsylvania School of Medicine, Philadelphia, PA; and the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin, Milwaukee, WI; in collaboration with the Pediatric Emergency Care Applied Research Network. Dr. Alessandrini is currently with the Department of Pediatrics, University of Cincinnati College of Medicine, Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
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  • Judy A. Shea PhD,

    1. From the Department of Pediatrics (EAA, ERA) and the Department of Emergency Medicine (EAA), University of Pennsylvania School of Medicine and Emergency Medicine (EAA, ERA), The Children’s Hospital of Philadelphia, PA; the Department of Pediatrics, George Washington University School of Medicine (JMC), and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC; the Department of Medicine, Division of General Internal Medicine (JAS), University of Pennsylvania School of Medicine, Philadelphia, PA; and the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin, Milwaukee, WI; in collaboration with the Pediatric Emergency Care Applied Research Network. Dr. Alessandrini is currently with the Department of Pediatrics, University of Cincinnati College of Medicine, Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
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  • Marc H. Gorelick MD, MSCE

    1. From the Department of Pediatrics (EAA, ERA) and the Department of Emergency Medicine (EAA), University of Pennsylvania School of Medicine and Emergency Medicine (EAA, ERA), The Children’s Hospital of Philadelphia, PA; the Department of Pediatrics, George Washington University School of Medicine (JMC), and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC; the Department of Medicine, Division of General Internal Medicine (JAS), University of Pennsylvania School of Medicine, Philadelphia, PA; and the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin, Milwaukee, WI; in collaboration with the Pediatric Emergency Care Applied Research Network. Dr. Alessandrini is currently with the Department of Pediatrics, University of Cincinnati College of Medicine, Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
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  • Presented at the Pediatric Academic Societies meetings, Washington, DC, May 2005, and San Francisco, CA, May 2006.

  • Funding was obtained through a HRSA Emergency Medical Services for Children Targeted Issues Grant (Grant H34MC02547).

Address for correspondence: Evaline A. Alessandrini, MD, MSCE; e-mail: evaline.alessandrini@cchmc.org. Reprints will not be available.

Abstract

Objectives:  A clinically sensible system of grouping diseases is needed for describing pediatric emergency diagnoses for research and reporting. This project aimed to create an International Classification of Diseases (ICD)-based diagnosis grouping system (DGS) for child emergency department (ED) visits that is 1) clinically sensible with regard to how diagnoses are grouped and 2) comprehensive in accounting for nearly all diagnoses (>95%). The second objective was to assess the construct validity of the DGS by examining variation in the frequency of targeted groups of diagnoses within the concepts of season, age, sex, and hospital type.

Methods:  A panel of general and pediatric emergency physicians used the nominal group technique and Delphi surveys to create the DGS. The primary data source used to develop the DGS was the Pediatric Emergency Care Applied Research Network (PECARN) Core Data Project (PCDP).

Results:  A total of 3,041 ICD-9 codes, accounting for 98.9% of all diagnoses in the PCDP, served as the basis for creation of the DGS. The expert panel developed a DGS framework representing a clinical approach to the diagnosis and treatment of pediatric emergency patients. The resulting DGS has 21 major groups and 77 subgroups and accounts for 96.5% to 99% of diagnoses when applied to three external data sets. Variations in the frequency of targeted groups of diagnoses related to seasonality, age, sex, and site of care confirm construct validity.

Conclusions:  The DGS offers a clinically sensible method for describing pediatric ED visits by grouping ICD-9 codes in a consensus-derived classification scheme. This system may be used for research, reporting, needs assessment, and resource planning.

ACADEMIC EMERGENCY MEDICINE 2010; 17:204–213 © 2010 by the Society for Academic Emergency Medicine

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