Accuracy of ICD-9 Codes for Identifying Children With Cerebral Sinovenous Thrombosis
Division of Pediatric Neurology, Indiana University School of Medicine, Indianapolis 46202, USA.Journal of Child Neurology (Impact Factor: 1.72). 02/2007; 22(1):45-8. DOI: 10.1177/0883073807299959
Childhood sinovenous thrombosis is rare, making it difficult to study; International Classification of Diseases, ninth revision (ICD-9), code searches across multiple hospitals would permit the identification of large numbers of children with sinovenous thrombosis. However, the accuracy of these codes for identifying childhood sinovenous thrombosis has not been established. We performed a retrospective search of admissions records for Riley Hospital for Children in Indianapolis, Indiana, from January 1999 to June 2005 using ICD-9 codes 325 (cerebral sinovenous thrombosis, excluding nonpyogenic cases and cases associated with pregnancy and the puerperium), 437.6 (cerebral venous thrombosis of nonpyogenic origin), and 671.5 (cerebral venous thrombosis in pregnancy or the puerperium) in any position. During this period, there were 47042 admissions. ICD-9 code 325 identified 61 admissions on 56 children. Only 13% were of pyogenic origin. Fifty-two (92.9%) had "possible, probable, or definite" sinovenous thrombosis, but only 76.9% of those had "probable or definite" sinovenous thrombosis. Uncertainty in diagnoses stemmed from limitations in imaging and disagreement over interpretation of imaging studies. ICD-9 code 325 in the primary position identified 7 children; all had possible (n = 1), probable (n = 1), or definite (n = 5) sinovenous thrombosis. ICD-9 code 437.6 identified a single admission on a single case of probable cerebral venous thrombosis; it was unclear whether this case was "nonpyogenic." ICD-9 code 671.5 did not identify any children. ICD-9 code 325 is useful for identifying children likely to have sinovenous thrombosis, but it is not useful for differentiating pyogenic and nonpyogenic cases, and uncertainty in clinical diagnosis makes it difficult to gauge the true accuracy. Furthermore, it is important to search for the code in any position as limiting searches to the primary position misses most cases.
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ABSTRACT: The data regarding diagnosis, prognosis, management, and outcome of patients with cerebral venous thrombosis are limited from the United States. Patients with diagnosis of cerebral venous thrombosis were identified by International Classification of Diseases, Ninth Revision coding system at 10 centers in the United States during a 10-year period by retrospective chart review (1991-1997) or prospective enrollment (1997-2001). In all, 232 patients were screened for study inclusion and 182 of these patients were included in the study. The age range was 13 to 82 years (mean 38 years). Hypercoagulable state was the most common predisposing factor followed by pregnancy, malignancy, and homocystinemia. Neurologic examination revealed normal findings in 69 patients (38%); 37 (20%) were comatose, 59 (32%) had papilledema, and 71 (39%) had hemiparesis. In all, 61 patients (33%) had evidence of hemorrhage by computed tomography/magnetic resonance imaging. A total of 27 patients (15%) were treated with thrombolysis and 124 (68%) with anticoagulation. Overall mortality was 13% (n = 24). One-year follow up was available for 96 patients (53%). Of these, 26 (27%) were healthy, 43 (45%) were ambulatory with assistance, and 27 (28%) were still bedridden. On multivariate analysis, the best predictors of a poor outcome were coma at presentation (odds ratio 15.2 [95% confidence interval; 1.5-66]) and intracerebral hemorrhage (odds ratio 8.7 [95% confidence interval; 1.3-34.5]). Clinical and radiologic presentation of cerebral venous thrombosis in the United States is not much different from other parts of world but spectrum and frequency of predisposing factors are different. Number of patients treated with thrombolysis is higher as compared with other reported series of such patients. Coma at presentation and intracerebral hemorrhage were the strongest predictors of poor outcome, which is comparable with other series.
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ABSTRACT: Few studies have examined when children with neonatal sinovenous thrombosis come to medical attention, risk factors associated with time of presentation, what clinical presentations are more likely to occur early or late, or whether the timing of presentation or severity of clinical presentation correlate with radiographic findings. Chi-square and Fisher's exact tests were used to explore associations in a cohort of 59 neonates with sinovenous thrombosis. Most (66%) came to medical attention within 48 hours of birth (defined as early presentation). Most (88%) had multiple comorbidities. Respiratory distress (P = 0.005), hypoxia (P = 0.02), poor tone (P = 0.05), fetal distress (P < 0.001), preterm delivery (P = 0.044), and low Apgar score (P = 0.018) were associated with early presentation. Infant dehydration was associated with late presentation (P < 0.001). Time of presentation was not associated with radiographic severity. Presentation with difficult-to-control seizures was marginally associated with hemorrhage (P = 0.096) but no other measure of radiographic severity. Neonates with sinovenous thrombosis often present within 48 hours, with multiple comorbidities and presenting signs, some of which are associated with time of presentation. Neither timing of presentation nor presence or absence of severe seizures can be used to predict findings on radiographic imaging.
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ABSTRACT: Nontraumatic intracranial hemorrhages (ICHs) are uncommon in children, but are important causes of death and injury. To determine whether the risk factors for ICH have changed compared with those in earlier published series and to estimate the residual deficits in the survivors. We performed a retrospective review of patients admitted to a single tertiary care, academic pediatric hospital from January 1, 2000, through May 31, 2007. Records were retrieved if the diagnostic codes from the International Classification of Diseases, Ninth Revision, were pertinent to ICHs. We searched reports from computed tomograms and magnetic resonance images of the brain for terms pertaining to ICH. Risk factors and functional outcome. Secondary measures were hemorrhage type and clinical presentation. We identified 85 children who had nontraumatic ICH. There were 10 subarachnoid, 61 intracerebral, and 14 subdural hemorrhages. Intracranial vascular anomalies were the most frequent risk factor, followed by congenital heart disease and brain tumors. Arteriovenous malformations did not account for as large a percentage as in previous studies. Twenty-nine children died. Of the 48 survivors for whom follow-up information was available, 26 had no reported deficits and 22 had deficits ranging from mild to severe. In this series, brain tumors and congenital heart disease accounted for a greater proportion of ICHs than in previous studies. The mortality due to ICH remains high but may be related as much to the severity of the underlying illnesses as to the hemorrhage itself. We found significant long-term morbidity, but more than half of the survivors for whom follow-up data were available had no detectable deficits. A long-term outcome study of pediatric ICH is needed.
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