Hospitalisations due to bacterial gastroenteritis: A comparison of surveillance and hospital discharge data

Abstract

Studies estimating the human health impact of the foodborne disease often include estimates of the number of gastroenteritis hospitalisations. The aims of this study were to examine the degree to which hospital discharge data underreport hospitalisations due to bacterial gastroenteritis and to estimate the frequency of stool sample submission among patients presenting with gastroenteritis. Using linked laboratory and hospital discharge data from a healthcare organisation and its affiliated hospital, we examined the International Classification of Disease (ICD-9-CM) diagnosis codes assigned to hospitalised adults with culture-confirmed Campylobacter, Salmonella, or Escherichia coli O157 infections and determined the frequency of stool sample submission. Among 138 hospitalised patients with culture-confirmed infections, 43% of Campylobacter patients, 56% of Salmonella patients and 35% of E. coli O157 patients had that pathogen-specific code listed on the discharge record. Among patients without their infection listed as a diagnosis, 65% were assigned a nonspecific gastroenteritis code. Submitting a specimen for culture ⩾3 days before discharge was significantly associated with having the pathogen-specific diagnosis listed. Of 6181 patients assigned a nonspecific gastroenteritis code, 69% had submitted a stool sample for bacterial culture. This study can be used to understand differences and adjust for the underreporting and underdiagnosed of Campylobacter, Salmonella and E. coli O157 in hospital discharge and surveillance data, respectively.

Keywords: Campylobacter; Escherichia coli (E. coli); Salmonella; gastroenteritis; hospital discharge data; surveillance.

Fig. 1.

Percentage of hospitalised patients ⩾18 years of age with a culture-confirmed Campylobacter, Salmonella, or E. coli O157 infection who submitted a specimen for bacterial culture <3 days and 3+ days before discharge from hospital and the proportion of these patients who had the culture-confirmed diagnosis listed as an ICD-9-CM diagnosis code on the hospital discharge record, Marshfield Clinic, Wisconsin, 1 January 2004–31 December 2014 (1 January 2004–31 December 2013 for E. coli O157).