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Query: UMLS:C0032285 (pneumonia)
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Objective: To determine the ability of risk adjustment methods that use routinely collected administrative data to explain variability in complication rates after hysterectomy.Methods: Discharge data on all non-radical hysterectomies performed in North Carolina between January 1988 and September 1994 were obtained from the North Carolina Medical Database Commission. Complications were categorized as 1) surgical (eg, hemorrhage, organ injury) and 2) medical (eg, myocardial infarction, pneumonia). Comorbidities included peritoneal adhesions and chronic medical problems. Hospital charges were adjusted for inflation. Univariate analyses were performed using the Kruskall-Wallis test for skewed continuous variables and chi(2) tests for categorical variables. Multivariate analysis was performed using unconditional logistic regression, with complication rate as the dependent variable.Results: There were 107,648 cases performed at 134 hospitals, with an overall complication rate of 9.5%. When cancer and pregnancy cases were excluded, the surgical complication rate was 5.0%, medical 3.2%. Patients with surgical complications were significantly younger (median age 42 vs 46) and had significantly higher total hospital charges (median $8,127 vs $7,496) than patients with medical complications. Complication rates for individual hospitals varied from 1.5% to 29.3%, with rates highest for academic medical centers (24.3% vs 7.2% for non-teaching hospitals). Significant predictors of complications in univariate analyses included type of hysterectomy, indication, age >/=65 years, insurance status, and teaching hospital status. Coded comorbid conditions were variable in their association with complications. Adjusted odds ratios, controlled for indication and type of procedure, for age >/=65, Medicaid or no insurance, and teaching hospital status were all greater for medical complications than for surgical complications in multivariate analysis (table).The predictive ability of multivariate analysis was better for medical complications than for surgical complications (C-statistic for medical complication model 0.763 vs 0.644 for surgical complications).Conclusions: Surgical complications of hysterectomy are more common, occur in younger women, and are associated with higher hospital charges than medical complications. Complication rates vary widely between hospitals, with teaching hospitals having the highest rates. This difference persists after adjustment for coded comorbidities. Possible explanations for the inability of multivariate analysis to explain the wide range in observed complication rates include 1) shortcomings in the available data or models, such as variability in coding practices between hospitals or variability in surgical difficulty between hospitals that is not captured with ICD-9-CM codes (eg, uterine size, cancer stage) and 2) variability in the quality of care between hospitals. Further research is needed to help determine the role of each of these explanations. Risk adjustment methods that use administrative data based on currently available coding standards are poor predictors of surgical complication rates after hysterectomy and should not be used to reach conclusions about quality of care.
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PMID:Risk adjustment for complications of hysterectomy: utility of routinely collected administrative data. 1083 85

To assess the value of ICD-9 coded chief complaints for early detection of epidemics, we measured sensitivity, positive predictive value, and timeliness of Influenza detection using a respiratory set (RS) of ICD-9 codes and an Influenza set (IS). We also measured inherent timeliness of these data using the cross-correlation function. We found that, for a one-year period, the detectors had sensitivity of 100% (1/1 epidemic) and positive predictive values of 50% (1/2) for RS and 25% (1/4) for IS. The timeliness of detection using ICD-9 coded chief complaints was one week earlier than the detection using Pneumonia and Influenza deaths (the gold standard). The inherent timeliness of ICD-9 data measured by the cross-correlation function was two weeks earlier than the gold standard.
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PMID:Value of ICD-9 coded chief complaints for detection of epidemics. 1182 78

Community acquired pneumonia (CAP) remains an important cause of substantial morbidity and mortality in inhospital patients. We conducted a retrospective study of all patients hospitalised at our hospital with the diagnosis of bacterial pneumonia according to ICD-10 within one year. Of 360 identified charts, 335 met the requirements and were reviewed regarding risk factors, diagnosis, treatment, and overall mortality. The typical patient hospitalised with pneumonia was elderly (mean 68 years), male (60%), and suffered from comorbidities or predisposing factors (96.4%). A total of 72.8% of pneumonias were localized in the inferior lobes, and 21.1% had bilateral infiltrates. Etiologic agents were searched for in 297/335 patients (87.5%) and were found positive in 33.4%: of 169 blood cultures 9.5% were positive, of 150 sputum cultures taken 46.6% were positive, of 17 serologies taken 58.8% were positive, and of 9 pleural effusions analysed 22.2% were positive. Encapsulated bacteria were the most common found bacterial etiologies, namely Streptococcus pneumoniae (S. pneumoniae) in 30.9% of patients with known bacterial etiology, Haemophilus in 24.7%, and Klebsiella in 12.4%. Methicillin-resistant S. aureus was not found. The three most commonly used antibiotics were amoxicillin/clavulanic acid used in 77.3% of patients, clarithromycin (41.2%), and ceftriaxone (16.6%). Mean duration of treatment was 12.1 days. 245/335 (73.1%) patients had a favourable outcome, 16.7% (56/335) of patients had a protracted illness with delayed resolution (i.e. prolonged hospital stay, need for intensive care, intubation or several of these complications). Overall mortality in our unit was 8.6%.
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PMID:A year's review of bacterial pneumonia at the central hospital of Lucerne, Switzerland. 1187 53

Community-acquired pneumonia (CAP) is a frequent cause of hospital admission and death among elderly patients, but there is little information on age- and sex-specific incidence, patterns of care (intensive care unit admission and mechanical ventilation), resource use (length of stay and hospital costs), and outcome (mortality). We conducted an observational cohort study of all Medicare recipients, aged 65 years or older, hospitalized in nonfederal U.S. hospitals in 1997, who met ICD-9-CM-based criteria for CAP. We identified 623,718 hospital admissions for CAP (18.3 per 1,000 population > or = 65 years), of which 26,476 (4.3%) were from nursing homes and of which 66,045 (10.6%) died. The incidence rose five-fold and mortality doubled as age increased from 65-69 to older than 90 years. Men had a higher mortality, both unadjusted (odds ratio [OR]: 1.21 [95% CI: 1.19-1.23]) and adjusted for age, location before admission, underlying comorbidity, and microbiologic etiology (OR: 1.15 [95% CI: 1.13-1.17]). Mean hospital length of stay and costs per hospital admission were 7.6 days and $6,949. For those admitted to the intensive care unit (22.4%) and for those receiving mechanical ventilation (7.2%), mean length of stay and costs were 11.3 days and $14,294, and 15.7 days and $23,961, respectively. Overall hospital costs were $4.4 billion (6.3% of the expenditure in the elderly for acute hospital care), of which $2.1 billion was incurred by cases managed in intensive care units. We conclude that in the hospitalized elderly, CAP is a common and frequently fatal disease that often requires intensive care unit admission and mechanical ventilation and consumes considerable health care resources. The sex differences are of concern and require further investigation.
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PMID:Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. 1271 45

This study aims to assess mortality trends of nonmalignant respiratory diseases from 1975 through 1997 in the population of Andalusia (a region of Spain in the southwest, population 7,000,000). The death records containing codes 460-519 of the International Classification of Diseases, Eighth Revision (ICD-8) and Ninth Revision (ICD-9) in effect through the 23-year period were used in this study. Deaths from nonmalignant respiratory diseases accounted for 12.4 and 10% of all deaths in males and females in 1975 and for 12.1 and 8.3% in 1997. Crude death rates decreased from 107.5 to 102.7 per 100,000 amongst men, and from 76.9 to 62.2 per 100,000 amongst women. Age-adjusted death rates decreased from 167.6 to 111.6 per 100,000 in men and from 84.4 to 41.2 per 100,000 in women. Age-adjusted death rate by potential years of life lost decreased from 5.8 to 2.4 per 1000 in men and from 2.4 to 0.8 per 1000 in women. Total percentage of change, adjusted by age, showed a decrease of 24.3% in men and 45.9% in women. Gender-adjusted rates for each category of nonmalignant respiratory disorders showed an upward trend of obstructive lung diseases in men and a downward trend of diseases of the upper airways and pneumonia both in men and women. Specific death rates by age groups for 1975-1985 and 1986-1997 showed an increased in mortality in infants under 1 year of age and in abrupt decrease up to the age of 50 followed by an exponential increase up to the age of 85.
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PMID:Mortality from non-malignant respiratory diseases in Andalusia, Spain, 1975-1997. 1218 17

The objective of this study was to develop a medical language processing (MLP) system, which consisted of MedLEE and a set of inference rules, to identify 19 Charlson comorbidities from discharge summaries and chest x-ray reports. We used 233 cases to learn the patterns that were indicative of comorbidities for developing the inference rules. We then used an independent data set of 3,662 pneumonia patients to identify comorbidities by MLP compared with administrative data (ICD-9 codes). A stratified random sample of 190 records from disagreement cases was manually reviewed. The sensitivity, specificity, and accuracy for the MLP system/ICD-9 codes in this testing set were 0.84/0.16, 0.70/0.30, and 0.77/0.23 respectively. Thirteen of the 19 comorbidities studied were underreported in the administrative data. The kappa values ranged from 0.19 for peptic ulcer to 0.70 for lymphoma. We conclude that comorbidities derived from natural language processing of medical records can improve ICD-9-based approaches.
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PMID:A comparison of the Charlson comorbidities derived from medical language processing and administrative data. 1246 7

The purpose of this paper is to describe the statistical impact of the Tenth Revision of the International Classification of Diseases (ICD-10) on cause-of-death data for the United States. ICD-10 was implemented in the U.S. effective with deaths occurring in 1999. The paper is based on cause-of-death information from a large sample of 1996 death certificates filed in the 50 States and the District of Columbia. Cause-of-death information in the sample includes underlying cause of death classified by both ICD-9 and ICD-10. Preliminary comparability ratios by cause of death presented in this paper indicate the extent of discontinuities in cause-of-death trends from 1998 to 1999 resulting from implementing ICD-10. For some leading causes (for example, septicaemia, influenza and pneumonia, Alzheimer's disease, and nephritis, nephrotic syndrome and nephrosis) the discontinuity in trend is substantial. Results of this study, although preliminary, are essential to analysing trends in mortality statistics between ICD-9 and ICD-10. In particular, the results provide a means for interpreting changes between 1998, which is the last year in which ICD-9 was used, and 1999, the year in which ICD-10 was implemented for mortality in the United States. Published in 2003 by John Wiley & Sons, Ltd.
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PMID:Disease classification: measuring the effect of the Tenth Revision of the International Classification of Diseases on cause-of-death data in the United States. 1270 15

To determine if physicians have improved the recognition and treatment of osteoporosis in patients with an acute hip fracture, we performed a retrospective analysis of discharge data from 1995 and 2000 at the University of Pittsburgh Medical Center, a large tertiary care, academic institution. We examined patients admitted with an acute hip fracture in 1995 and 2000 and age- and sex-matched patients admitted with community acquired pneumonia in 2000. Outcomes included age, gender, race, discharge diagnoses (from ICD-9 codes) and discharge medications (from discharge summaries) in all patients. There were 136 acute hip fracture patients (mean age 73+/-18 years) in 1995, 117 acute hip fracture patients (mean age 76+/-16 years) in 2000 and 116 patients with community-acquired pneumonia (mean age 78+/-7 years). Patients admitted in 2000 with an acute hip fracture were more likely to be diagnosed with osteoporosis (18% vs. 4%, P<0.02), more likely to be discharged on calcium (17% vs. 7%, P<0.02) and more likely to be discharged on antiresorptive therapy (15% vs. 2%, P<0.001) than those admitted in 1995. Moreover, patients admitted with community-acquired pneumonia were just as likely to receive calcium, vitamin D or antiresorptive agents at the time of discharge as those with an acute hip fracture in 2000. Patients with a diagnosis of osteoporosis in 2000 were older and more likely to receive antiresorptive agents than those without a diagnosis (29% vs. 11%, P<0.05). None of the patients received a bone mineral density examination while in the hospital. Although there was an improvement in the management of osteoporosis after an acute hip fracture from 1995 to 2000, there was no difference in management of patients with hip fracture versus pneumonia in the year 2000. However, patients with a "diagnosis" of osteoporosis in 2000 were more likely to be discharged on appropriate therapeutic options. We conclude that although we have improved our care of osteoporosis for elderly in general from 1995 to 2000, patients with an acute hip fracture are not receiving any additional treatment unless they have a diagnosis of osteoporosis. Further studies are needed to determine which factors are needed to target patients for appropriate diagnosis and treatment.
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PMID:The management of osteoporosis following hip fracture: have we improved our care? 1513 66

This study attempts to overcome the problem of under-reporting of serious pneumococcal infection in the Republic of Ireland by adding a proportion of 'unspecified' disease to pneumococcal disease reports. ICD-9 data for all age groups was collected on meningitis (from the National Disease Surveillance Centre), and septicaemia and pneumonia (from the Hospital In-Patient Enquiry system) for the year 1999. A 7-valent pneumococcal conjugate vaccine (PCV) has been shown to have significant effectiveness in the target paediatric age group and also indirect herd effects on the US adult population. The implications of these direct and indirect effects were applied to the epidemiology of serious pneumococcal infection in Ireland. The annual reported incidence rates for laboratory confirmed severe pneumococcal disease in Ireland in 1999 may underestimate both the morbidity and mortality of disease by 21% and 28% respectively. In all age groups 1,183 cases and 132 deaths may be prevented annually by the introduction of the vaccine. In addition, the vaccine provides an effective new tool for reducing disease caused by antibiotic resistant pneumococci thus assisting in the control of anti-microbial resistance in humans.
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PMID:The burden of severe pneumococcal infection in Ireland: potential effectiveness and indirect benefits of the 7-valent pneumococcal conjugate vaccine. 1556 87

A prospective cohort study of adult patients hospitalized due to community-acquired pneumonia was carried out for 1 year in a Brazilian university general hospital to detect the incidence of community-acquired pneumonia by Legionella pneumophila serogroups 1-6. During a whole year, a total of 645 consecutive patients who were hospitalized due to a initial presumptive diagnosis of respiratory disease by ICD-10 (J00-J99), excluding upper respiratory diseases, were screened to detect the patients with community-acquired pneumonia. Fifty-nine consecutive patients hospitalized due to community-acquired pneumonia between July 19, 2000 and July 18, 2001, were included in the study. They had determinations of serum antibodies to L. pneumophila serogroups 1-6 by indirect immunofluorescence antibody test at the Infectious Diseases Laboratory of University of Louisville (KY, USA) and urinary antigen tests for L. pneumophila serogroup 1. Three patients had community-acquired pneumonia by L. pneumophila serogroups 1-6, two patients being diagnosed by seroconversion and positive urinary antigen tests; the other had negative serologies but strongly positive urinary antigen test. The incidence of community-acquired pneumonia by L. pneumophila serogroups 1-6 in our hospital was 5.1%.
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PMID:Community-acquired pneumonia by Legionella pneumophila serogroups 1-6 in Brazil. 1595 Jan 37


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