Identifying Acute Neuropsychiatric Events in Children and Adolescents

Antoon, James W.; Feinstein, James A.; Grijalva, Carlos G; Zhu, Yuwei; Dickinson, Emily; Stassun, Justine; Johnson, Jakobi; Sekmen, Mert; Tanguturi, Yasas; Gay, James C.; Williams, Derek J.

doi:10.1542/hpeds.2021-006329

Cited by 5 publications

(3 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Study strengths include use of a large database, highly specific and validated outcome measurement, and influenza season definition designed to minimize exposure misclassification . Limitations include the lack of information on vaccination status, virus type, and children younger than 5 years.…”

Section: Discussionmentioning

confidence: 99%

“…For each influenza episode, follow-up started on the diagnosis date and continued through the earliest of follow-up day 10, loss of enrollment, end of season, death, or the outcome: neuropsychiatric event resulting in hospitalization. Serious neuropsychiatric events were identified using an established algorithm with a positive predictive value of 90% that included neurologic and psychiatric events. The rate of serious neuropsychiatric events was calculated by dividing the number of events by the total influenza person-time (per 100 000 person-weeks of influenza).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Population-Based Incidence of Influenza-Associated Serious Neuropsychiatric Events in Children and Adolescents

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Population-Based Incidence of Influenza-Associated Serious Neuropsychiatric Events in Children and Adolescents

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…Influenza diagnosis was defined by the presence or absence of an influenza ICD-10 discharge diagnosis code (eAppendix in Supplement 1). 18 Influenza diagnosis positive (ICD-10 positive) was defined as the presence of an influenza ICD-10 code among individuals discharged from the ED or influenza ICD-10 code among hospitalized individuals. Influenza diagnosis negative (ICD-10 negative) was defined as the absence of an influenza ICD-10 discharge diagnosis code.…”

Section: Influenza Diagnosis Definitionmentioning

confidence: 99%

Accuracy of Influenza ICD-10 Diagnosis Codes in Identifying Influenza Illness in Children

Antoon,

Stopczynski,

Amarin

et al. 2024

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

ImportanceStudies of influenza in children commonly rely on coded diagnoses, yet the ability of International Classification of Diseases, Ninth Revision codes to identify influenza in the emergency department (ED) and hospital is highly variable. The accuracy of newer International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes to identify influenza in children is unknown.ObjectiveTo determine the accuracy of ICD-10 influenza discharge diagnosis codes in the pediatric ED and inpatient settings.Design, Setting, and ParticipantsChildren younger than 18 years presenting to the ED or inpatient settings with fever and/or respiratory symptoms at 7 US pediatric medical centers affiliated with the Centers for Disease Control and Prevention–sponsored New Vaccine Surveillance Network from December 1, 2016, to March 31, 2020, were included in this cohort study. Nasal and/or throat swabs were collected for research molecular testing for influenza, regardless of clinical testing. Data, including ICD-10 discharge diagnoses and clinical testing for influenza, were obtained through medical record review. Data analysis was performed in August 2023.Main Outcomes and MeasuresThe accuracy of ICD-10–coded discharge diagnoses was characterized using molecular clinical or research laboratory test results as reference. Measures included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Estimates were stratified by setting (ED vs inpatient) and age (0-1, 2-4, and 5-17 years).ResultsA total of 16 867 children in the ED (median [IQR] age, 2.0 [0.0-4.0] years; 9304 boys [55.2%]) and 17 060 inpatients (median [IQR] age, 1.0 [0.0-4.0] years; 9798 boys [57.4%]) were included. In the ED, ICD-10 influenza diagnoses were highly specific (98.0%; 95% CI, 97.8%-98.3%), with high PPV (88.6%; 95% CI, 88.0%-89.2%) and high NPV (85.9%; 95% CI, 85.3%-86.6%), but sensitivity was lower (48.6%; 95% CI, 47.6%-49.5%). Among inpatients, specificity was 98.2% (95% CI, 98.0%-98.5%), PPV was 82.8% (95% CI, 82.1%-83.5%), sensitivity was 70.7% (95% CI, 69.8%-71.5%), and NPV was 96.5% (95% CI, 96.2%-96.9%). Accuracy of ICD-10 diagnoses varied by patient age, influenza season definition, time between disease onset and testing, and clinical setting.Conclusions and RelevanceIn this large cohort study, influenza ICD-10 discharge diagnoses were highly specific but moderately sensitive in identifying laboratory-confirmed influenza; the accuracy of influenza diagnoses varied by clinical and epidemiological factors. In the ED and inpatient settings, an ICD-10 diagnosis likely represents a true-positive influenza case.

show abstract

Incidence of Influenza-associated Neurologic and Psychiatric Complications Requiring Hospitalization in Children Ages 5–17 Years

Quertermous,

Williams,

Bruce

et al. 2024

Pediatric Infectious Disease Journal

View full text Add to dashboard Cite

Background: The spectrum and incidence of influenza-associated neuropsychiatric complications are not well-characterized. The objective of this study was to define the incidence of specific neurologic and psychiatric complications associated with influenza in children and adolescents. Methods: We assembled a retrospective cohort of children 5–17 years of age with an outpatient or emergency department International Classification of Diseases, 10th revision influenza diagnosis and enrolled in Tennessee Medicaid from 2016 to 2020. Serious neurologic or psychiatric complications requiring hospitalization were identified using a validated algorithm. Incidence rates of complications were expressed per 100,000 person-weeks of influenza and 95% confidence intervals (CIs) were reported. Results: A total of 156,611 influenza encounters (median age of 9.3 years) were included. The overall incidence of neurologic complications was 30.5 (95% CI: 24.0–38.6) per 100,000 person-weeks of influenza and 1880.9 (95% CI: 971.9–3285.5) among children with an underlying neurologic comorbidity. The distribution of antiviral treatment was similar among those with and without neurologic or psychiatric complications. The overall incidence of psychiatric complications was 20.2 (95% CI: 15.1–27.0) per 100,000 person-weeks of influenza and 111.8 (95% CI: 77.9–155.5) among children with an underlying psychiatric comorbidity. Seizures (17.5, 95% CI: 12.8–23.9) were the most common neurologic complications whereas encephalitis (0.5, 95% CI: 0.02–2.5) was rare. Mood disorders (17.5, 95% CI: 12.8–23.9) were the most frequent psychiatric complications and self-harm events (0.9, 95% CI: 0.3–3.3) were the least common. Discussion: Our findings reveal that the incidence of neuropsychiatric complications of influenza is overall low; however, the incidence among children with underlying neurologic or psychiatric condition is significantly higher than among children without these conditions.

show abstract

Identifying Acute Neuropsychiatric Events in Children and Adolescents

Cited by 5 publications

References 22 publications

Population-Based Incidence of Influenza-Associated Serious Neuropsychiatric Events in Children and Adolescents

Population-Based Incidence of Influenza-Associated Serious Neuropsychiatric Events in Children and Adolescents

Accuracy of Influenza ICD-10 Diagnosis Codes in Identifying Influenza Illness in Children

Incidence of Influenza-associated Neurologic and Psychiatric Complications Requiring Hospitalization in Children Ages 5–17 Years

Contact Info

Product

Resources

About