Measuring complications of serious pediatric emergencies using ICD‐10

ObjectiveTo create definitions for complications for 16 serious pediatric conditions using the International Classification of Diseases, 10th Revision, Clinical Modification or Procedure Coding System (ICD‐10‐CM/PCS), and to assess whether complication rates are similar to those measured with ICD‐9‐CM/PCS.Data SourcesThe Healthcare Cost and Utilization Project State Emergency Department and Inpatient Databases from five states between 2014 and 2017 were used to identify cases and assess complication rates. Incidences were calculated using population counts from the 5‐year American Community Survey.Data Collection/Extraction MethodsPatients were identified by the presence of a diagnosis code for one of the 16 serious conditions. Only the first encounter for a given condition by a patient was included. Encounters resulting in transfer were excluded as the presence of complications was unknown.Study DesignWe defined complications using data elements routinely available in administrative databases including ICD‐10‐CM/PCS codes. The definitions were adapted from ICD‐9‐CM/PCS using general equivalence mappings and refined using consensus opinion. We included 16 serious conditions: appendicitis, bacterial meningitis, compartment syndrome, new‐onset diabetic ketoacidosis (DKA), ectopic pregnancy, empyema, encephalitis, intussusception, mastoiditis, myocarditis, orbital cellulitis, ovarian torsion, sepsis, septic arthritis, stroke, and testicular torsion. Using data from children under 18 years, we compared incidences and complication rates across the ICD‐10‐CM/PCS transition for each condition using interrupted time series.Principal FindingsThere were 61 314 ED visits for a serious condition; the most common was appendicitis (n = 37 493). Incidence rates for each condition were not significantly different across the ICD‐10‐CM/PCS transition for 13/16 conditions. Three differed: empyema (increased 42%), orbital cellulitis (increased 60%), and sepsis (increased 26%). Complication rates were not significantly different for each condition across the ICD‐10‐CM/PCS transition, except appendicitis (odds ratio 0.62, 95% CI 0.57‐0.68), DKA (OR 3.79, 95% CI 1.92‐7.50), and orbital cellulitis (OR 0.53, 95% CI 0.30‐0.95).ConclusionsFor most conditions, incidences and complication rates were similar before and after the transition to ICD‐10‐CM/PCS codes, suggesting our system identifies complications of conditions in administrative data similarly using ICD‐9‐CM/PCS and ICD‐10‐CM/PCS codes. This system may be applied to screen for cases with complications and in health services research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167093/1/hesr13615-sup-0003-FigureS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167093/2/hesr13615_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167093/3/hesr13615-sup-0001-Authormatrix.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167093/4/hesr13615.pd

Structure-acitivity studies and analgesic efficacy of N-(3-pyridinyl)-bridged bicyclic diamines, exceptionally potent agonists at nicotinic acetylcholine receptors

A series of exceptionally potent agonists at neuronal nicotinic acetylcholine receptors (nAChRs) has been investigated. Several N-(3-pyridinyl) derivatives of bridged bicyclic diamines exhibit double-digit-picomolar binding affinities for the alpha4beta2 subtype, placing them with epibatidine among the most potent nAChR ligands described to date. Structure-activity studies have revealed that substitutions, particularly hydrophilic groups in the pyridine 5-position, differentially modulate the agonist activity at ganglionic vs central nAChR subtypes, so that improved subtype selectivity can be demonstrated in vitro. Analgesic efficacy has been achieved across a broad range of pain states, including rodent models of acute thermal nociception, persistent pain, and neuropathic allodynia. Unfortunately, the hydrophilic pyridine substituents that were shown to enhance agonist selectivity for central nAChRs in vitro tend to limit CNS penetration in vivo, so that analgesic efficacy with an improved therapeutic window was not realized with those compounds