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Multicenter Study of Surveillance for Hospital-Onset Clostridium difficile Infection by the Use of ICD-9-CM Diagnosis Codes

Published online by Cambridge University Press:  02 January 2015

Erik R. Dubberke ,
Anne M. Butler ,
Deborah S. Yokoe ,
Jeanmarie Mayer ,
Bala Hota ,
Julie E. Mangino ,
Yosef M. Khan ,
Kyle J. Popovich ,
Kurt B. Stevenson  and
L. Clifford McDonald
...Show all authors
Erik R. Dubberke*
Affiliation:
Washington University School of Medicine, St Louis, Missouri
Anne M. Butler
Affiliation:
Washington University School of Medicine, St Louis, Missouri
Deborah S. Yokoe
Affiliation:
Brigham and Women's Hospitaland Harvard Medical School, Boston, Massachusetts
Jeanmarie Mayer
Affiliation:
University of Utah Hospital, Salt Lake City, Utah
Bala Hota
Affiliation:
Stroger Hospital of Cook County/Rush University Medical Center, Chicago, Illinois
Julie E. Mangino
Affiliation:
Ohio State University Medical Center, Columbus, Ohio
Yosef M. Khan
Affiliation:
Ohio State University Medical Center, Columbus, Ohio
Kyle J. Popovich
Affiliation:
Stroger Hospital of Cook County/Rush University Medical Center, Chicago, Illinois
Kurt B. Stevenson
Affiliation:
Ohio State University Medical Center, Columbus, Ohio
L. Clifford McDonald
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Margaret A. Olsen
Affiliation:
Washington University School of Medicine, St Louis, Missouri
Victoria J. Fraser
Affiliation:
Washington University School of Medicine, St Louis, Missouri
*
Box 8051, 660 South Euclid, St Louis, MO 63110 ([email protected])
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Extract

Objective.

To compare incidence of hospital-onset Clostridium difficile infection (CDI) measured by the use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) discharge diagnosis codes with rates measured by the use of electronically available C. difficile toxin assay results.

Methods.

Cases of hospital-onset CDI were identified at 5 US hospitals during the period from July 2000 through June 2006 with the use of 2 surveillance definitions: positive toxin assay results (gold standard) and secondary ICD-9-CM discharge diagnosis codes for CDI. The x2 test was used to compare incidence, linear regression models were used to analyze trends, and the test of equality was used to compare slopes.

Results.

Of 8,670 cases of hospital-onset CDI, 38% were identified by the use of both toxin assay results and the ICD-9-CM code, 16% by the use of toxin assay results alone, and 45% by the use of the ICD-9-CM code alone. Nearly half (47%) of cases of CDI identified by the use of a secondary diagnosis code alone were community-onset CDI according to the results of the toxin assay. The rate of hospital-onset CDI found by use of ICD-9-CM codes was significantly higher than the rate found by use of toxin assay results overall (P<.001), as well as individually at 3 of the 5 hospitals (P<.001 for all). The agreement between toxin assay results and the presence of a secondary ICD-9-CM diagnosis code for CDI was moderate, with an overall k value of 0.509 and hospital-specific k values of 0.489–0.570. Overall, the annual increase in CDI incidence was significantly greater for rates determined by the use of ICD-9-CM codes than for rates determined by the use of toxin assay results (P = .006).

Conclusions.

Although the ICD-9-CM code for CDI seems to be adequate for measuring the overall CDI burden, use of the ICD-9-CM discharge diagnosis code for CDI, without present-on-admission code assignment, is not an acceptable surrogate for surveillance for hospital-onset CDI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 3 , March 2010 , pp. 262 - 268
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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