Accuracy of Malignant Hyperthermia Diagnoses in Hospital Discharge Records

Pinyavat, Teeda; Rosenberg, Henry; Lang, Barbara H.; Wong, Cynthia A.; Riazi, Sheila; Brady, Joanne E.; Sun, Lena S.; Li, Guohua

doi:10.1097/aln.0000000000000467

Cited by 21 publications

(16 citation statements)

References 11 publications

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“…However, a general anesthetic may be required after a vaginal delivery in some circumstances such as the removal of a retained placenta or an exploration of the uterine cavity because of a postpartum hemorrhage. Moreover, as indicated in our previous study, most of the MH diagnoses in hospital discharge records refer to positive MH history and susceptibility rather than acute MH episodes [25]. These two factors may explain why the prevalence of MH diagnosis in vaginal delivery was much lower than in cesarean delivery (0.29 per 100,000 versus 0.81 per 100,000.…”

Section: National Inpatientmentioning

confidence: 64%

“…Second, identification of MH diagnosis relies on the accuracy of coding in discharges data and is susceptible to misclassification because of error or absence of coding. In a previous study evaluating the accuracy of MH diagnosis in hospital discharge records, we found that the ICD-9-CM code 995.86 ("Malignant hyperthermia due to anesthesia") corresponded to a MH crisis in 24% of the cases, to a MH history in 47%, and to fever unrelated to MH in 24% [25]. Therefore, most of the cases with an MH diagnosis identified in the present study should be regarded as MH susceptibility rather than incident MH episodes.…”

Section: National Inpatientmentioning

confidence: 95%

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Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014

Guglielminotti

Rosenberg

2020

BMC Anesthesiol

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Background: The cost-benefit of stocking dantrolene in maternity units for treating malignant hyperthermia (MH) has been recently questioned because of the low incidence of MH crisis in the general population and the low utilization of general anesthesia in obstetrics. However, no study has examined the prevalence of MH susceptibility in obstetrics. This study aimed to assess the prevalence of MH diagnosis and associated factors in obstetric patients. Methods: Data for this study came from the National Inpatient Sample from 2003 to 2014, a 20% nationally representative sample of discharge records from community hospitals. A diagnosis of MH due to anesthesia was identified using the International Classification of Diseases, Ninth Revision, Clinical Modification code 995.86. MH prevalence was estimated according to the delivery mode and patient and hospital characteristics. Results: During the 12-year study period, 47,178,322 delivery-related discharges [including 15,175,127 (32.2%) cesarean deliveries] were identified. Of them, 215 recorded a diagnosis of MH, yielding a prevalence of 0.46 per 100, 000 [95% confidence interval (CI), 0.40 to 0.52]. The prevalence of MH diagnosis in cesarean deliveries was 0.81 per 100,000 (95% CI, 0.67 to 0.97), compared with 0.29 per 100,000 (95% CI, 0.23 to 0.35) in vaginal deliveries (P < 0.001). Multivariable logistic regression revealed that cesarean delivery was associated with a significantly increased risk of MH diagnosis [adjusted rate ratio (aOR) 2.88; 95% CI, 2.19 to 3.80]. Prevalence of MH diagnosis was lower in Hispanics than in non-Hispanic whites (aOR 0.47; 95% CI, 0.29 to 0.76) and higher in the South than in the Northeast census regions (aOR 2.44; 95% CI, 1.50 to 3.96). Conclusion: The prevalence of MH-susceptibility is about 1 in 125,000 in cesarean deliveries, similar to the prevalence reported in non-obstetrical surgery inpatients. The findings of this study suggest that stocking dantrolene in maternity units is justified.

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Section: National Inpatientmentioning

confidence: 64%

Section: National Inpatientmentioning

confidence: 95%

Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014

Guglielminotti

Rosenberg

2020

BMC Anesthesiol

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“…There is no test that can be applied acutely to distinguish MH from other causes of hypermetabolism or hyperthermia [4]. The symptoms may occur at any time during the perioperative period and can be highly variable.…”

Section: Discussionmentioning

confidence: 99%

“…The benefits of using dantrolene with our patient certainly outweighed the risks, resulting in a favorable outcome, but such prudent clinical decisions may have long-lasting effects. Pinyavat et al explain that miscoding for MH, preemptively treating suspicious cases with dantrolene (as with our case), and even simply having a family member with the disease have contributed to a significant number of cases being added to Medicaid and Medicare databases, as well as individual state hospital discharge databases, listing MH as “present on admission,” and have resulted in MH being identified as a preexisting condition [4]. Without confirmation via the caffeine-halothane contracture test, we will never be certain of the diagnosis with our patient.…”

Section: Discussionmentioning

confidence: 99%

“…While the confirmation of the diagnosis is still pending, the patient's medical record mentions a high suspicion of MH susceptibility and subsequent treatment with dantrolene. The inability to rapidly confirm a diagnosis or even perform the gold-standard biopsy test in a single hospital admission can result in suspected or inaccurately diagnosed cases ending up as a preexisting condition in a patient's permanent medical record [4]. Denial of insurance coverage, exorbitant premiums, and discrimination based on preexisting conditions has garnered enough attention to result in various legislative protections, but the risk of repeal of current policies and implementation of new healthcare campaigns may have profound effects on the affordability or eligibility of insurance for patients who carry the diagnosis of MH.…”

Section: Introductionmentioning

confidence: 99%

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A Case Report of Suspected Malignant Hyperthermia: How Will the Diagnosis Affect a Patient’s Insurability?

Osman

Saba

Watson

2018

Case Reports in Anesthesiology

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The purpose of this case report is to increase awareness that a diagnosis of malignant hyperthermia may have long-lasting or permanent effects on a patient's insurance eligibility or premiums despite legislation providing varying levels of protection from preexisting conditions or genetic discrimination. We present a case of severe rigors, unexplained severe metabolic acidosis, and severe hyperthermia in a patient after general anesthesia for extensive head and neck surgery. The patient was treated for malignant hyperthermia and demonstrated a significant clinical improvement with the administration of dantrolene. Even with an “almost certain” diagnosis of malignant hyperthermia by clinical presentation, genetic testing was negative and the gold-standard caffeine-halothane contracture test has yet to be performed. Laboratory results, clinical grading scales, and genetic testing support a diagnosis of malignant hyperthermia but the gold standard is a live muscle biopsy and caffeine-halothane contracture test. A clinical diagnosis of MH or a positive caffeine-halothane contracture test could result in exclusion from genetic discrimination legislature due to the fact that diagnosis can be confirmed without genetic testing. The fate of the Affordable Care Act may also affect how insurance companies scrutinize this disease. Improving accuracy of MH diagnosis in hospital discharge records will be crucial.

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