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. 2014;23(6):568-73.
doi: 10.1159/000364780. Epub 2014 Jul 24.

Diagnosis of influenza: only a problem of coding?

Emanuele Amodio  1 , Fabio Tramuto, Claudio Costantino, Vincenzo Restivo, Carmelo Maida, Giuseppe Calamusa, Francesco Vitale
Affiliations

Diagnosis of influenza: only a problem of coding?

Emanuele Amodio et al. Med Princ Pract. 2014.

Abstract

Objective: To evaluate the characteristics of hospital discharge diagnoses of influenza measured by using specific International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) codes.

Subjects and methods: The study was conducted for the 3 years 2007, 2008 and 2011. The database included (1) administrative and clinical data on Sicilian patients admitted to acute care hospitals and (2) data from the influenza virological surveillance of 10 European countries (FluNet database). All Sicilian patients diagnosed with at least 1 ICD-9 CM code for influenza (487.0, 487.1 and 487.9) were considered influenza cases.

Results: Overall, 2,880 patients with an ICD-9 CM code attributable to influenza were hospitalized in Sicily: 2,119 (73.6%) were admitted from November to April, whereas 761 (26.4%) were admitted from May to October. In the 3 years studied, the analyzed European influenza surveillance systems recorded a peak of laboratory-confirmed influenza activity from November to April with 36,753 (99.7%) influenza cases, whereas only 124 cases (0.3%) were observed from May to October.

Conclusions: In Sicily, more than one quarter of all hospital admissions with an ICD-9 CM code for influenza were observed in the months with a negligible circulation of influenza viruses. Our findings show that several hospital discharge records included ICD-9 CM codes for influenza with low levels of sensitivity, specificity and/or appropriateness for clinical information and support the need for improving medical education on the epidemiology and hospital management of influenza cases.

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Figures

Fig. 1
Fig. 1
Annual number of patients hospitalized in Sicily with ICD-9 CM codes for influenza infection as well as for specified and unspecified viral pneumonia.
Fig. 2
Fig. 2
a Number of patients hospitalized in Sicily (2007, 2008 and 2011) with an ICD-9 CM code for influenza infection. b Aggregate percentage of laboratory-confirmed influenza cases in Italy, Croatia, France, Germany, Greece, Poland, Portugal, Romania, Spain and Switzerland.
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