Validation of ICD-10 codes for severe maternal morbidity at delivery in a public hospital.

BACKGROUND: Severe maternal morbidity is a composite measure of serious obstetric complications that is often identified in administrative data using International Classification of Diseases (ICD) diagnosis and procedure codes for a set of 21 indicators. Prior studies of screen-positive cases have demonstrated low predictive value for ICD codes relative to the medical record. To our knowledge, the validity of ICD-10 codes for identifying severe maternal morbidity has not been fully described. METHODS: We estimated the sensitivity, specificity, positive predictive value, and negative predictive value of ICD-10 codes for severe maternal morbidity occurring at delivery, compared with medical record abstraction (gold standard), for 1,000 deliveries that took place during 2016-2018 at a large, public hospital. RESULTS: We identified a total of 67 cases of severe maternal morbidity using the ICD-10 definition, and 74 cases in the medical record. The sensitivity was 26% (95% confidence interval (CI): 16%, 37%), the positive predictive value was 28% (95% CI: 18%, 41%), the specificity was 95% (95% CI: 93%, 96%), and the negative predictive value was 94% (95% CI: 92%, 96%). CONCLUSIONS: The validity of ICD-10 codes for severe maternal morbidity in our high-burden population was poor, suggesting considerable potential for bias.

The intersection of pediatrics, climate change, and structural racism: Ensuring health equity through climate justice.

Understanding and intervening at the intersection of climate change and child health disparities require pediatric providers to broaden their competency with structural determinants of health - even in the clinic. The environmental effects of climate change at the community level intersect in complex ways with structural racism and social influences of health. Climate injustice is further evident in policies and practices that disproportionately affect low-income communities and communities of color through exposure to harmful pollutants from industrial plants, heavy vehicular traffic, and flooding waterways, as well as to harm from degraded civic infrastructure such as leaking water lines and unsafe bridges. To support child health, pediatric providers must recognize the environmental health harms posed to children and multiplied by climate change as well as identify opportunities to center the voices of families and communities to dismantle these inequities. In this article, three case examples demonstrate the links between structural racism, climate change and child health. We then use a healing centered engagement approach to offer specific suggestions for how pediatric providers can actively promote health and resilience, advocate for patient needs, and contribute to efforts to change structural racism in existing practices and institutions.