Comparison of <i>International Classification of Diseases and Related Health Problems, Tenth Revision</i> Codes With Electronic Medical Records Among Patients With Symptoms of Coronavirus Disease 2019

Crabb, Brendan T.; Lyons, Ann; Bale, Margaret; Martin, Valérie; Berger, Ben; Mann, Sara; West, William B.; Brown, Alyssa; Peacock, Jordan B.; Leung, Daniel T.; Shah, Rashmee U.

doi:10.1001/jamanetworkopen.2020.17703

Cited by 34 publications

(40 citation statements)

References 12 publications

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“…Also, many individuals with covid-19 might not seek medical care unless the symptoms are unusually long lasting or severe. ICD-10 codes have been shown to be valid for many clinical diagnoses45 but are inaccurate and unreliable for determining symptoms 46. Therefore, we intentionally did not evaluate a broad list of symptoms in this study as we expect that the true incidence of symptoms was not accurately reflected when determined by ICD-10 codes and would be best established through patient reported surveys.…”

Section: Discussionmentioning

confidence: 99%

Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study

Daugherty

Guo

Heath

et al. 2021

BMJ

332

347

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Objective To evaluate the excess risk and relative hazards for developing incident clinical sequelae after the acute phase of SARS-CoV-2 infection in adults aged 18-65. Design Retrospective cohort study. Setting Three merged data sources from a large United States health plan: a large national administrative claims database, an outpatient laboratory testing database, and an inpatient hospital admissions database. Participants Individuals aged 18-65 with continuous enrollment in the health plan from January 2019 to the date of a diagnosis of SARS-CoV-2 infection. Three comparator groups, matched by propensity score, to individuals infected with SARS-CoV-2: a 2020 comparator group, an historical 2019 comparator group, and an historical comparator group with viral lower respiratory tract illness. Main outcome measures More than 50 clinical sequelae after the acute phase of SARS-CoV-2 infection (defined as the date of first SARS-CoV-2 diagnosis (index date) plus 21 days) were identified using ICD-10 (international classification of diseases, 10th revision) codes. Excess risk in the four months after acute infection and hazard ratios with Bonferroni corrected 95% confidence intervals were calculated. Results 14% of adults aged ≤65 who were infected with SARS-CoV-2 (27 074 of 193 113) had at least one new type of clinical sequelae that required medical care after the acute phase of the illness, which was 4.95% higher than in the 2020 comparator group. The risk for specific new sequelae attributable to SARS-Cov-2 infection after the acute phase, including chronic respiratory failure, cardiac arrythmia, hypercoagulability, encephalopathy, peripheral neuropathy, amnesia (memory difficulty), diabetes, liver test abnormalities, myocarditis, anxiety, and fatigue, was significantly greater than in the three comparator groups (2020, 2019, and viral lower respiratory tract illness groups) (all P<0.001). Significant risk differences because of SARS-CoV-2 infection ranged from 0.02 to 2.26 per 100 people (all P<0.001), and hazard ratios ranged from 1.24 to 25.65 compared with the 2020 comparator group. Conclusions The results indicate the excess risk of developing new clinical sequelae after the acute phase of SARS-CoV-2 infection, including specific types of sequelae less commonly seen in other viral illnesses. Although individuals who were older, had pre-existing conditions, and were admitted to hospital because of covid-19 were at greatest excess risk, younger adults (aged ≤50), those with no pre-existing conditions, or those not admitted to hospital for covid-19 also had an increased risk of developing new clinical sequelae. The greater risk for incident sequelae after the acute phase of SARS-CoV-2 infection is relevant for healthcare planning.

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Section: Discussionmentioning

confidence: 99%

Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study

Daugherty

Guo

Heath

et al. 2021

BMJ

332

347

View full text Add to dashboard Cite

show abstract

“…Reliance on these administrative data will likely remain important for prior COVID-19 disease identification, particularly given expanding interest in identifying legacy effects and post-acute sequelae of SARS-CoV-2 (PASC) infection. However, ICD-10 codes in other clinical settings 4 and for COVID-19-related symptoms 5 are known to be subject to misclassification.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of ICD-10 Diagnostic Codes to Identify COVID-19 Among Hospitalized Patients

et al. 2021

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“…ICD-10 codes have been shown to be valid for many clinical diagnoses (45), but an inaccurate and unreliable method for ascertaining symptoms. (46) Therefore, we intentionally did not evaluate a broad list of symptoms in this study as we anticipate the true incidence of symptoms are not accurately reflected when ascertained by ICD-10 codes and would be best ascertained through patient-reported surveys.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 infection and risk of clinical sequelae during the post-acute phase: a retrospective cohort study

Yang

Heath

et al. 2021

Preprint

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Objective: Clinical sequelae have not been well characterized during the post-acute phase of SARS-CoV-2 among adults 18 to 65 years old, and this study sought to fill that gap by evaluating excess risk and relative hazards for developing incident clinical sequelae during the post-acute phase. Design: Retrospective cohort study including three propensity-matched groups. Setting: This study merged three data sources from a large United States health plan: a large national administrative claims database, an outpatient lab testing database, and an inpatient hospital admissions database. Participants: Individuals 18 to 65 years old with continuous health plan enrollment from January 2019 to date of SARS-CoV-2 diagnosis. Three comparator groups were identified and propensity-score matched to individuals infected with SARS-CoV-2: a 2020 comparator group, a historical 2019 comparator group and a historical comparator group with viral lower respiratory tract illness (vLRTI). Main outcome measures: Over 50 clinical sequelae during the post-acute phase (index date + 21 days) were ascertained using ICD-10 codes. Excess risk due to SARS-CoV-2 during the 4 months following the acute phase of illness and hazard ratios with 95% Bonferroni-corrected confidence intervals were calculated. Results: This study found 14% of adults ≤65 years of age who were infected with SARS-CoV-2 (n=193113) had at least one new clinical sequelae that required medical attention during the post-acute phase of illness. When considering risk for specific sequelae attributable to SARS-Cov-2 infection during the post-acute phase, clinical outcomes including chronic respiratory failure, cardiac arrythmia, hypercoagulability, encephalopathy, peripheral neuropathy, amnesia (memory difficulty), diabetes, liver test abnormalities, myocarditis, anxiety and fatigue were significantly elevated compared to the three propensity-matched comparator groups (2020, 2019, vLRTI). Significant risk differences due to SARS-CoV-2 infection ranged from 0.02 to 2.26 per 100 people and hazard ratios ranged from 1.24 to 25.65 when compared to the 2020 comparator group. Conclusions: Our results confirm excess risk for developing clinical sequelae due to SARS-CoV-2 during the post-acute phase, including specific types of sequelae less commonly seen among other viral illnesses. Although individuals who were older, had pre-existing conditions, and were hospitalized due to COVID-19 were at greatest excess risk, younger adults (≤50 years), adults who did not have pre-existing conditions or adults who were not hospitalized due to COVID-19 were still at elevated risk for developing new clinical sequelae. The elevated risk for incident sequelae during the post-acute phase is relevant for healthcare planning.

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Comparison of International Classification of Diseases and Related Health Problems, Tenth Revision Codes With Electronic Medical Records Among Patients With Symptoms of Coronavirus Disease 2019

Cited by 34 publications

References 12 publications

Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study

Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study

Accuracy of ICD-10 Diagnostic Codes to Identify COVID-19 Among Hospitalized Patients

SARS-CoV-2 infection and risk of clinical sequelae during the post-acute phase: a retrospective cohort study

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