Evaluation of using ICD-10 code data for respiratory syncytial virus surveillance

Abstract

Background: Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory tract infection (ALRI) in young children. ICD-10-based syndromic surveillance can transmit data rapidly in a standardized way.

Objectives: We investigated the use of RSV-specific ICD-10 codes for RSV surveillance.

Methods: We performed a retrospective descriptive data analysis based on existing ICD-10-based surveillance systems for ALRI in primary and secondary care and a linked virological surveillance in Germany. We described RSV epidemiology and compared the epidemiological findings based on ICD-10 and virological data. We calculated sensitivity and specificity of RSV-specific ICD-10 codes and in combination with ICD-10 codes for acute respiratory infections (ARI) for the identification of laboratory-confirmed RSV infections.

Results: Based on the ICD-10 and virological data, epidemiology of RSV was described, and common findings were found. The RSV-specific ICD-10 codes had poor sensitivity 6% (95%-CI: 3%-12%) and high specificity 99.8% (95%-CI: 99.6%-99.9%). In children <5 years and in RSV seasons, the sensitivities of RSV-specific ICD-10 codes combined with general ALRI ICD-10 codes J18.-, J20.- and with J12.-, J18.-, J20.-, J21.-, J22 were moderate (44%, 95%-CI: 30%-59%). The specificities of both combinations remained high (91%, 95%-CI: 86%-94%; 90%, 95%-CI: 85%-94%).

Conclusions: The use of RSV-specific ICD-10 codes may be a useful indicator to describe RSV epidemiology. However, RSV-specific ICD-10 codes underestimate the number of actual RSV infections. This can be overcome by combining RSV-specific and general ALRI ICD-10 codes. Further investigations are required to validate this approach in other settings.

Keywords: ICD-10 code; epidemiology; respiratory syncytial virus; sensitivity; specificity; surveillance.

Figure 1

Number of RSV‐ICD‐cases by age group and gender based on SEED^ARE, week 40/2007‐13/2017

Figure 2

RSV‐positive rate by age group and gender based on virological surveillance, week 40/2010‐18/2017

Figure 3

Integration of RSV data of practices participated in both SEED^ARE and virological surveillance, week 40/2010‐13/2017

Figure 4

Cumulative number of RSV‐ICD‐cases based on SEED^ARE and cumulative number of confirmed‐RSV‐cases based on virological surveillance by calendar week in the practices participated in both SEED^ARE and virological surveillance, week 40/2010‐18/2017

Figure 5

Proportion of RSV‐ICD‐cases based on SEED^ARE and RSV positive rate based on virological surveillance by calendar week in the practices participated in both SEED^ARE and virological surveillance, week 40/2010‐18/2017

Figure 6

Number on RSV‐ICD‐cases by age group and gender based on ICOSARI, week 01/2009‐15/2017