Hospital-based medical records are abstracted to create International Classification of Disease (ICD) coded discharge health data in many countries. The 'main condition' is not defined in a consistent manner internationally. Some countries employ a 'reason for admission' rule as the basis for the main condition, while other countries employ a 'resource use' rule. A few countries have recently transitioned from one of these approaches to the other. The definition of 'main condition' in such ICD data matters when it is used to define a disease cohort to assign diagnosis-related groups and to perform risk adjustment. We propose a method of harmonizing the international definition to enable researchers and international organizations using ICD-coded health data to aggregate or compare hospital care and outcomes across countries in a consistent manner. Inter-observer reliability of alternative harmonization approaches should be evaluated before finalizing the definition and adopting it worldwide.

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A new coding feature introduced with ICD-11, the 11th revision of the International Classification of Diseases (ICD), is postcoordination, which supports combining (linking) two or more codes into a cluster that describes a clinical concept. Postcoordination allows for coded data to be reported to a greater level of specificity than was possible in previous version of ICD. The linked codes are kept together in a cluster when submitted for reporting. This article presents background detail on the postcoordination feature in ICD and the postcoordination tool. Also presented are several examples that demonstrate the flexibility that ICD-11 provides for enriching coded health information.

In 75 patients with acute pneumonia of moderate severity a comparative study between transtracheal aspiration (TTA), sputum culture and epipharynx culture was carried out. Organisms considered as the probable etiological agent were found in 53% with TTA. The same organisms were found in only 27% in sputum samples and in 21% in epipharynx samples. No serious complications with TTA was noted.