Developing a Diagnosis-based Severity Classification System for Use in Emergency Medical Services for Children

Authors

  • Evaline A. Alessandrini MD, MSCE,

    1. From the Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children’s Hospital and Medical Center (EAA), Cincinnati, OH; the Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia (ERA), Philadelphia, PA; the Departments of Pediatrics and Emergency Medicine, George Washington University School of Medicine, and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC; the Department of Medicine, Division of General Internal Medicine, University of Pennsylvania School of Medicine (JAS), Philadelphia, PA; the Department of Pediatrics, University of Utah Health Sciences (RH), Salt Lake City, UT; and the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin (MHG), Milwaukee, WI.
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  • Elizabeth R. Alpern MD, MSCE,

    1. From the Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children’s Hospital and Medical Center (EAA), Cincinnati, OH; the Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia (ERA), Philadelphia, PA; the Departments of Pediatrics and Emergency Medicine, George Washington University School of Medicine, and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC; the Department of Medicine, Division of General Internal Medicine, University of Pennsylvania School of Medicine (JAS), Philadelphia, PA; the Department of Pediatrics, University of Utah Health Sciences (RH), Salt Lake City, UT; and the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin (MHG), Milwaukee, WI.
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  • James M. Chamberlain MD,

    1. From the Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children’s Hospital and Medical Center (EAA), Cincinnati, OH; the Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia (ERA), Philadelphia, PA; the Departments of Pediatrics and Emergency Medicine, George Washington University School of Medicine, and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC; the Department of Medicine, Division of General Internal Medicine, University of Pennsylvania School of Medicine (JAS), Philadelphia, PA; the Department of Pediatrics, University of Utah Health Sciences (RH), Salt Lake City, UT; and the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin (MHG), Milwaukee, WI.
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  • Judy A. Shea PhD,

    1. From the Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children’s Hospital and Medical Center (EAA), Cincinnati, OH; the Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia (ERA), Philadelphia, PA; the Departments of Pediatrics and Emergency Medicine, George Washington University School of Medicine, and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC; the Department of Medicine, Division of General Internal Medicine, University of Pennsylvania School of Medicine (JAS), Philadelphia, PA; the Department of Pediatrics, University of Utah Health Sciences (RH), Salt Lake City, UT; and the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin (MHG), Milwaukee, WI.
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  • Richard Holubkov PhD,

    1. From the Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children’s Hospital and Medical Center (EAA), Cincinnati, OH; the Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia (ERA), Philadelphia, PA; the Departments of Pediatrics and Emergency Medicine, George Washington University School of Medicine, and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC; the Department of Medicine, Division of General Internal Medicine, University of Pennsylvania School of Medicine (JAS), Philadelphia, PA; the Department of Pediatrics, University of Utah Health Sciences (RH), Salt Lake City, UT; and the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin (MHG), Milwaukee, WI.
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  • Marc H. Gorelick MD, MSCE,

    1. From the Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children’s Hospital and Medical Center (EAA), Cincinnati, OH; the Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia (ERA), Philadelphia, PA; the Departments of Pediatrics and Emergency Medicine, George Washington University School of Medicine, and the Division of Emergency Medicine, Children’s National Medical Center (JMC), Washington, DC; the Department of Medicine, Division of General Internal Medicine, University of Pennsylvania School of Medicine (JAS), Philadelphia, PA; the Department of Pediatrics, University of Utah Health Sciences (RH), Salt Lake City, UT; and the Department of Pediatrics, Medical College of Wisconsin and Section of Emergency Medicine, Children’s Hospital of Wisconsin (MHG), Milwaukee, WI.
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  • for the Pediatric Emergency Care Applied Research Network

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  • Presented in part at the Pediatric Academic Societies Meetings, May 2007, Toronto, Ontario, Canada.

  • Funding was obtained through an HRSA Emergency Medical Services for Children (EMSC) Targeted Issues Grant (Grant H34MC02547) and The Pediatric Emergency Care Applied Research Network (PECARN) is supported by cooperative agreements U03MC00001, U03MC00003, U03MC00006, U03MC00007, and U03MC00008 from the EMSC program of the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services.

  • The authors have no further disclosures or conflicts of interest to report.

  • Supervising Editor: Lowell Gerson, PhD.

Address for correspondence and reprints: Evaline A. Alessandrini, MD, MSCE; e-mail: evaline.alessandrini@cchmc.org.

Abstract

ACADEMIC EMERGENCY MEDICINE 2012; 19:70–78 © 2012 by the Society for Academic Emergency Medicine

Abstract

Objectives:  Lack of adequate risk adjustment methodologies has hindered the progress of emergency medicine health services research. The authors hypothesized that a consensus-derived, diagnosis-based severity classification system (SCS) would be significantly associated with actual measures of emergency department (ED) resource use and could ultimately be used to examine severity-adjusted outcomes across patient populations.

Methods:  A panel of subject matter experts used consensus methods to assign severity scores (1 = lowest severity to 5 = highest severity) to 3,041 ED International Classifications of Diseases (ICD), 9th revision, diagnosis codes. SCS scores were assigned to ED visits using the visit diagnosis code with the highest severity. We tested the association between the SCS scores and measures of ED resource use in three data sets: the Pediatric Emergency Care Applied Research Network Core Data Project (PCDP), the National Hospital Ambulatory Medical Care Survey (NHAMCS), and the Connecticut state ED data set.

Results:  There was a significant association between the five-level SCS and all six measures of resource use: triage category, disposition, ED resource use, Current Procedural Terminology Evaluation and Management (CPT E&M) codes, ED length of stay, and ED charges within the three ED data sets.

Conclusions:  The SCS demonstrates validity in its strong association with actual ED resource use. The use of readily available ICD-9 diagnosis codes makes the SCS useful as a risk adjustment tool for health services research.

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