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Multicenter Study of Surveillance for Hospital-Onset Clostridium difficile Infection by the Use of ICD-9-CM Diagnosis Codes

Published online by Cambridge University Press:  02 January 2015

Erik R. Dubberke ,
Anne M. Butler ,
Deborah S. Yokoe ,
Jeanmarie Mayer ,
Bala Hota ,
Julie E. Mangino ,
Yosef M. Khan ,
Kyle J. Popovich ,
Kurt B. Stevenson  and
L. Clifford McDonald
...Show all authors
Erik R. Dubberke*
Affiliation:
Washington University School of Medicine, St Louis, Missouri
Anne M. Butler
Affiliation:
Washington University School of Medicine, St Louis, Missouri
Deborah S. Yokoe
Affiliation:
Brigham and Women's Hospitaland Harvard Medical School, Boston, Massachusetts
Jeanmarie Mayer
Affiliation:
University of Utah Hospital, Salt Lake City, Utah
Bala Hota
Affiliation:
Stroger Hospital of Cook County/Rush University Medical Center, Chicago, Illinois
Julie E. Mangino
Affiliation:
Ohio State University Medical Center, Columbus, Ohio
Yosef M. Khan
Affiliation:
Ohio State University Medical Center, Columbus, Ohio
Kyle J. Popovich
Affiliation:
Stroger Hospital of Cook County/Rush University Medical Center, Chicago, Illinois
Kurt B. Stevenson
Affiliation:
Ohio State University Medical Center, Columbus, Ohio
L. Clifford McDonald
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Margaret A. Olsen
Affiliation:
Washington University School of Medicine, St Louis, Missouri
Victoria J. Fraser
Affiliation:
Washington University School of Medicine, St Louis, Missouri
*
Box 8051, 660 South Euclid, St Louis, MO 63110 ([email protected])
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Extract

Objective.

To compare incidence of hospital-onset Clostridium difficile infection (CDI) measured by the use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) discharge diagnosis codes with rates measured by the use of electronically available C. difficile toxin assay results.

Methods.

Cases of hospital-onset CDI were identified at 5 US hospitals during the period from July 2000 through June 2006 with the use of 2 surveillance definitions: positive toxin assay results (gold standard) and secondary ICD-9-CM discharge diagnosis codes for CDI. The x2 test was used to compare incidence, linear regression models were used to analyze trends, and the test of equality was used to compare slopes.

Results.

Of 8,670 cases of hospital-onset CDI, 38% were identified by the use of both toxin assay results and the ICD-9-CM code, 16% by the use of toxin assay results alone, and 45% by the use of the ICD-9-CM code alone. Nearly half (47%) of cases of CDI identified by the use of a secondary diagnosis code alone were community-onset CDI according to the results of the toxin assay. The rate of hospital-onset CDI found by use of ICD-9-CM codes was significantly higher than the rate found by use of toxin assay results overall (P<.001), as well as individually at 3 of the 5 hospitals (P<.001 for all). The agreement between toxin assay results and the presence of a secondary ICD-9-CM diagnosis code for CDI was moderate, with an overall k value of 0.509 and hospital-specific k values of 0.489–0.570. Overall, the annual increase in CDI incidence was significantly greater for rates determined by the use of ICD-9-CM codes than for rates determined by the use of toxin assay results (P = .006).

Conclusions.

Although the ICD-9-CM code for CDI seems to be adequate for measuring the overall CDI burden, use of the ICD-9-CM discharge diagnosis code for CDI, without present-on-admission code assignment, is not an acceptable surrogate for surveillance for hospital-onset CDI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 3 , March 2010 , pp. 262 - 268
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Dallal, RM, Harbrecht, BG, Boujoukas, AJ, et al.Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 2002;235:363–372.Google Scholar
2.Muto, CA, Pokrywka, M, Shutt, K, et al.A large outbreak of Clostridium difficile–associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 2005;26:273–280.Google Scholar
3.Pepin, J, Valiquette, L, Alary, ME, et al.Clostridium difficile–associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466–472.Google Scholar
4.Pepin, J, Saheb, N, Coulombe, MA, et al.Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile–associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005;41:1254–1260.Google Scholar
5.McDonald, LC, Killgore, GE, Thompson, A, et al.An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:2433–2441.Google Scholar
6.Archibald, LK, Banerjee, SN, Jarvis, WR. Secular trends in hospital-acquired Clostridium difficile disease in the United States, 1987–2001. J Infect Dis 2004;189:1585–1589.Google Scholar
7.Loo, VG, Poirier, L, Miller, MA, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile–associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–2449.Google Scholar
8.McDonald, LC, Owings, M, Jernigan, DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003. Emerg Infect Dis 2006;12:409–415.Google Scholar
9.HHS Action Plan to Prevent Healthcare-Associated Infections. Washington, DC: US Department of Health and Human Services, http://www.hhs.gov/ophs/initiatives/hai/prevtargets.html. Accessed April 9, 2009.Google Scholar
10.Iezzoni, L. Coded data from administrative sources. In: Iezzoni, L, ed. Risk Adjustment for Measuring Health Care Outcomes. 3rd ed. Chicago, IL: Health Administration Press; 2009:83–138.Google Scholar
11.Klabunde, CN, Warren, JL, Legler, JM. Assessing comorbidity using claims data: an overview. Med Care 2002;40(8 Suppl):IV-26–35.Google Scholar
12.McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, PK. Recommendations for surveillance of Clostridium difficile–associated disease. Infect Control Hosp Epidemiol 2007;28:140–145.Google Scholar
13.Dubberke, ER, Reske, KA, McDonald, LC, Fraser, VJ. ICD-9-CM codes and surveillance for Clostridium difficile–associated disease. Emerg Infect Dis 2006;12:1576–1579.CrossRefGoogle ScholarPubMed
14.Scheurer, DB, Hicks, LS, Cook, EF, Schnipper, JL. Accuracy of ICD-9-CM coding for Clostridium difficile infections: a retrospective cohort. Epidemiol Infect 2007;135:1010–1013.Google Scholar
15. ICD-9-CM Official Guidelines for Coding and Reporting. Atlanta, GA: Centers for Disease Control and Prevention; 2005. http://www.cdc.gov/nchs/data/icd9/icdguide.pdf. Accessed January 15, 2010.Google Scholar
16.Hospital-Acquired Conditions (Present on Admission Indicator). Baltimore, MD: Centers for Medicare and Medicaid Services. http://wwwxms.hhs.gov/hospitalacqcond/. Accessed March 1, 2009.Google Scholar