Use of diagnosis codes for detection of clinically significant opioid poisoning in the emergency department: A retrospective analysis of a surveillance case definition
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Reardon, Joseph M, et al. Use of Diagnosis Codes for Detection of Clinically Significant Opioid Poisoning In the Emergency Department: A Retrospective Analysis of a Surveillance Case Definition. BioMed Central, 2016. https://doi.org/10.17615/0hjw-0787APA
Reardon, J., Harmon, K., Schult, G., Staton, C., & Waller, A. (2016). Use of diagnosis codes for detection of clinically significant opioid poisoning in the emergency department: A retrospective analysis of a surveillance case definition. BioMed Central. https://doi.org/10.17615/0hjw-0787Chicago
Reardon, Joseph M, Katherine J Harmon, Genevieve C Schult, Catherine A Staton, and Anna Waller. 2016. Use of Diagnosis Codes for Detection of Clinically Significant Opioid Poisoning In the Emergency Department: A Retrospective Analysis of a Surveillance Case Definition. BioMed Central. https://doi.org/10.17615/0hjw-0787- Creator
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Reardon, Joseph M
- Other Affiliation: Division of Emergency Medicine, Duke University, 2301 Erwin Rd, Box 3935, Durham, NC 27710, USA
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Harmon, Katherine J
- Affiliation: Injury Prevention Research Center
- Other Affiliation: Carolina Center for Health Informatics
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Schult, Genevieve C
- Affiliation: School of Medicine, Department of Emergency Medicine
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Staton, Catherine A
- Other Affiliation: Division of Emergency Medicine, Duke University, 2301 Erwin Rd, Box 3935, Durham, NC 27710, USA; Duke Global Health Institute, Duke University, 310 Trent Dr, Durham 27710NC, USA
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Waller, Anna
- Affiliation: School of Medicine, Department of Emergency Medicine, Injury Prevention Research Center
- Other Affiliation: Carolina Center for Health Informatics
- Abstract
- Abstract Background Although fatal opioid poisonings tripled from 1999 to 2008, data describing nonfatal poisonings are rare. Public health authorities are in need of tools to track opioid poisonings in near real time. Methods We determined the utility of ICD-9-CM diagnosis codes for identifying clinically significant opioid poisonings in a state-wide emergency department (ED) surveillance system. We sampled visits from four hospitals from July 2009 to June 2012 with diagnosis codes of 965.00, 965.01, 965.02 and 965.09 (poisoning by opiates and related narcotics) and/or an external cause of injury code of E850.0-E850.2 (accidental poisoning by opiates and related narcotics), and developed a novel case definition to determine in which cases opioid poisoning prompted the ED visit. We calculated the percentage of visits coded for opioid poisoning that were clinically significant and compared it to the percentage of visits coded for poisoning by non-opioid agents in which there was actually poisoning by an opioid agent. We created a multivariate regression model to determine if other collected triage data can improve the positive predictive value of diagnosis codes alone for detecting clinically significant opioid poisoning. Results 70.1 % of visits (Standard Error 2.4 %) coded for opioid poisoning were primarily prompted by opioid poisoning. The remainder of visits represented opioid exposure in the setting of other primary diseases. Among non-opioid poisoning codes reviewed, up to 36 % were reclassified as an opioid poisoning. In multivariate analysis, only naloxone use improved the positive predictive value of ICD-9-CM codes for identifying clinically significant opioid poisoning, but was associated with a high false negative rate. Conclusions This surveillance mechanism identifies many clinically significant opioid overdoses with a high positive predictive value. With further validation, it may help target control measures such as prescriber education and pharmacy monitoring.
- Date of publication
- February 8, 2016
- DOI
- Identifier
- Resource type
- Article
- Rights statement
- In Copyright
- Rights holder
- Reardon et al.
- Language
- English
- Bibliographic citation
- BMC Emergency Medicine. 2016 Feb 08;16(1):11
- Publisher
- BioMed Central
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