key: cord-0928128-smh0tz4d
authors: Blatz, Allison M; David, Michael Z; Otto, William R; Luan, Xianqun; Gerber, Jeffrey S
title: Validation of ICD-10 code for identifying children hospitalized with COVID-19
date: 2020-11-11
journal: J Pediatric Infect Dis Soc
DOI: 10.1093/jpids/piaa140
sha: 67b3cbef51368b2e7c25ae4586c954a813626068
doc_id: 928128
cord_uid: smh0tz4d

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M a n u s c r i p t

In December 2019, a cluster of cryptogenic severe pneumonia cases occurred in Wuhan, China. The etiology was identified as Severe Acute Respiratory Syndrome in January 2020 and the resultant illness was termed coronavirus disease of 2019 . 1 SARS-CoV-2 has since spread globally with >42,500,000 cases and >1,100,000 deaths by 10/24/2020. 2 Most published clinical studies on COVID-19 have been on small cohorts. Large administrative datasets will likely be used to more comprehensively describe the epidemiology and outcomes of patients hospitalized with COVID-19. An emergency International Classification of Disease 10 (ICD-10) code, "U07.1 COVID-19, virus identified" was introduced on 4/1/2020 and was expanded to include "Multisystem Inflammatory Syndrome in Children (MIS-C)" under the same code on 5/14/20. 3 However, the accuracy of this ICD-10 code in identifying patients with COVID-19 is unknown. In a small, early study of military data, only 20.3% of known COVID-19 cases were assigned this ICD-10 code. 4 We performed a single-center validation study of pediatric inpatients. Some data from this center have previously been reported. 5 Universal admission screening for SARS-CoV-2 began at our institution on 4/1/2020. We considered a patient to have COVID-19 if they tested positive for SARS-CoV-2 by polymerase chain reaction (PCR) or had a clinical diagnosis of MIS-C. A clinical diagnosis of MIS-C was made if a patient met CDC diagnostic criteria 6 and a multidisciplinary group of physicians decided this was the most likely diagnosis. After obtaining IRB approval at our academic, tertiary pediatric medical center, the institution's electronic health record (EHR) was queried for all admitted patients tested for SARS-CoV-2 by a PCR-based assay on a nasopharyngeal or endotracheal aspirate or were assigned a primary or secondary diagnosis code of "U07.1" from 4/1/2020 -8/1/2020. Any patient with a diagnosis of MIS-C from 5/14/20-8/1/20 was added if they were included A c c e p t e d M a n u s c r i p t on a comprehensive list maintained by our institution's MIS-C team (Supplemental table 1) .

Only initial hospital admission encounters were included for each unique subject. Subjects were classified as "U07.1 positive" if they were assigned an ICD-10 code of U07.1 or as "U07.1 negative" if that code was not assigned. Student's t-test and X 2 -test were used to Table 1 .

The sensitivity of the U07.1 ICD-10 code for identifying those with a positive SARS-CoV-2 PCR test was 90.5% (95% CI 82.8-94.6%; Figure 1) M a n u s c r i p t

In conclusion, ICD-10-based identification demonstrated high sensitivity and specificity for COVID-19 patients, which together yield an excellent area under the ROC curve. Our results may underestimate the accuracy of the U07.1 code in future studies because it may be more precisely used over time. Limitations of our study include that it was single-center study at a US children's hospital, and thus the generalizability of our findings to other settings and populations, especially with our use of universal admission screening, is unknown. Another limitation is that patients identified as false positives may have been tested for SARS-CoV-2 at an outside institution, though this would have been rare since our institution is the primary regional pediatric referral center. Our results suggest the U07.1 ICD-10 code may be a valid means of identifying patients with COVID-19 in administrative databases. Further studies are needed to confirm these results.

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COVID-19 Dashboard by the Center for Systems Science and Engineering

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Pediatric Healthcare Network in the United States

Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19). Health Alert Network

+ A patient is defined as COVID-19 positive if they had a positive PCR test for SARS-CoV-2 and/or met clinical criteria for MIS-C

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