A Research Model using Diagnostic Coding to investigate Pediatric Co-Morbidities

Author: A Dpsanjh

Background: The International Classification of Disease and Health related conditions (ICD) is an extensive and detailed coding system in its tenth year of revision. The ICD system offers an opportunity to study co-morbidities and associations in Pediatric disease pathogenesis. A model of investigation is proposed and a hypothesis used to illustrate the methodology. Premature birth is defined as birth at 37 weeks gestational age or less, and accounts for approximately 10% of all births. Illustrative Hypothesis: Among the premature infants born between January 1, 2014 and January 1, 2017, apnea may be more common, in comparison to full term infants admitted to the NICU. Among the premature infants with apnea, neonatal pneumonia was found in association in a subset of patients more often, than among the full term infants. Methods: 1) The health information system NICU discharge summaries were identified and using ICD codes for premature birth, neonatal apnea and neonatal pneumonia were searched to identify the numbers of patients with each ICD. 2) The same data base was searched for controls without premature birth ICD with and without apnea. 3) The search therefore yields subsets of patients for analysis. 4) For example: Premature infants= 1000 Full term infants = 1200 Premature infants with Apnea = 400 Full term infants with Apnea = 100 Premature infants with Apnea + Pneumonia = 100 Full term infants with Apnea and Pneumonia= 20 Other diagnoses may then be cross listed with each subset to further study the associations between conditions to expand the analysis. Statistical Analysis is then performed using an appropriate method eg student t test, and a p value of <0.05 is considered significant. This project concept offers a model of analysis which may be applied to a wide variety of areas of Pediatric and Medical investigation. The identification of novel cohorts for biomarker and gene expression profiles may potentially benefit from this project concept and its applications.

Co Author/Co-Investigator Names/Professional Title: A. Dosanjh M.D. Pediatric Pulmonologist San Diego, CA