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1.
Medicine (Baltimore) ; 99(12): e19568, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195966

RESUMEN

This study aimed to evaluate the relationship between Bell's palsy and rheumatoid arthritis in a national sample cohort from Korea.Data were collected for individuals ≥20 years old from 2002 to 2013 in the Korean National Health Insurance Service-National Sample Cohort. We extracted data for patients with rheumatoid arthritis (n = 7628) and 1:4-matched controls (n = 30,512) and analyzed the occurrence of Bell's palsy in both groups. Matching was performed based on age, sex, income, and region of residence. Rheumatoid arthritis was diagnosed according to International Classification of Disease-10 (ICD-10) codes (M05-M06) and the prescription of biological agents and/or disease-modifying antirheumatic drugs. Bell's palsy patients were diagnosed according to ICD-10 code H912 and treatment ≥2 times with steroids. Adjusted hazard ratios (HRs) were calculated using stratified Cox proportional hazard models for the Charlson comorbidity index and 95% confidence intervals (CIs). Subgroup analyses based on age and sex were also performed.The rates of Bell's palsy were similar between the rheumatoid arthritis group (0.5% [38/7628]) and the control group, with no significant difference (0.4% [124/30,512], P = .270). The adjusted HR for Bell's palsy was 1.12 (95% CI, 0.78-1.62) in the rheumatoid arthritis group (P = .540). In the subgroup analyses according to age and sex, the relationship between Bell's palsy and rheumatoid arthritis did not reach statistical significance.The risk of Bell's palsy was not increased in patients with rheumatoid arthritis.


Asunto(s)
Artritis Reumatoide/diagnóstico , Artritis Reumatoide/epidemiología , Parálisis de Bell/diagnóstico , Parálisis de Bell/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/complicaciones , Artritis Reumatoide/tratamiento farmacológico , Parálisis de Bell/tratamiento farmacológico , Comorbilidad , Femenino , Humanos , Incidencia , Clasificación Internacional de Enfermedades/normas , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , República de Corea/epidemiología , Factores de Riesgo , Adulto Joven
5.
Eur J Ophthalmol ; 30(1): 6-7, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31771348

RESUMEN

Diabetic retinopathy is a major cause worldwide of vision loss from diabetic maculopathy or proliferative retinopathy. Without widely accepted classifications of diabetic retinopathy and diabetic maculopathy, it is difficult to compare results of clinical trials or monitor clinical care. The European School of Advanced Studies in Ophthalmology has developed an international classification of diabetic maculopathy based upon spectral domain optical coherence tomography, which could be helpful for both initial evaluation and subsequent follow-up of diabetic patients in both clinical practice and experimental trials.


Asunto(s)
Retinopatía Diabética/clasificación , Edema Macular/clasificación , Retinopatía Diabética/diagnóstico por imagen , Humanos , Clasificación Internacional de Enfermedades , Edema Macular/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Tomografía de Coherencia Óptica/métodos
6.
Eur J Ophthalmol ; 30(1): 8-18, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31718271

RESUMEN

AIMS: To present an authoritative, universal, easy-to-use morphologic classification of diabetic maculopathy based on spectral domain optical coherence tomography. METHODS: The first draft of the project was developed based on previously published classifications and a literature search regarding the spectral domain optical coherence tomography quantitative and qualitative features of diabetic maculopathy. This draft was sent to an international panel of retina experts for a first revision. The panel met at the European School for Advanced Studies in Ophthalmology headquarters in Lugano, Switzerland, and elaborated the final document. RESULTS: Seven tomographic qualitative and quantitative features are taken into account and scored according to a grading protocol termed TCED-HFV, which includes foveal thickness (T), corresponding to either central subfoveal thickness or macular volume, intraretinal cysts (C), the ellipsoid zone (EZ) and/or external limiting membrane (ELM) status (E), presence of disorganization of the inner retinal layers (D), number of hyperreflective foci (H), subfoveal fluid (F), and vitreoretinal relationship (V). Four different stages of the disease, that is, early diabetic maculopathy, advanced diabetic maculopathy, severe diabetic maculopathy, and atrophic maculopathy, are based on the first four variables, namely the T, C, E, and D. The different stages reflect progressive severity of the disease. CONCLUSION: A novel grading system of diabetic maculopathy is hereby proposed. The classification is aimed at providing a simple, direct, objective tool to classify diabetic maculopathy (irrespective to the treatment status) even for non-retinal experts and can be used for therapeutic and prognostic purposes, as well as for correct evaluation and reproducibility of clinical investigations.


Asunto(s)
Retinopatía Diabética/clasificación , Retinopatía Diabética/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Anciano , Consenso , Europa (Continente) , Femenino , Humanos , Clasificación Internacional de Enfermedades , Edema Macular/clasificación , Edema Macular/diagnóstico por imagen , Masculino , Persona de Mediana Edad
8.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e19004.supl.3, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31800856

RESUMEN

INTRODUCTION: Reliable cause-of-death statistics are an important source of information on trends and differentials in population health. In Brazil, the Mortality Information System is responsible for compiling cause of death (CoD) data. Despite the success in reducing R-codes ill-defined causes of death, other garbage codes (GC), classified as causes that cannot be the underlying CoD, according to the Global Burden of Disease study, remain a challenge. The Ministry of Health (MoH) aims to decrease the proportion of all GCs, and a pilot study tested a comprehensive strategy to investigate GC deaths that occurred in 2015. METHODS: The research was conducted in seven Brazilian cities during five months in 2016: two rural cities, one metropolitan area, and four capitals. For all GCs selected, municipal healthcare workers collected information about the terminal disease from hospital records, autopsies, family health teams, and home investigation. The fieldwork was coordinated at Federal level in partnership with State and municipal teams. RESULTS: Out of 1,242 deaths selected, physicians analyzed the information collected and certified the CoD in 1,055 deaths, resulting in 92.6% of cases having their underlying cause changed to a usable ICD-10 code. DISCUSSION: It is noteworthy the capacity the health teams in the seven cities showed during the implementation of the pilot. CONCLUSION: After results analysis, the GC investigation protocol was modified, and the implementation scaled up to 60 cities in 2017.


Asunto(s)
Causas de Muerte , Exactitud de los Datos , Sistemas de Información/normas , Mejoramiento de la Calidad/normas , Adulto , Brasil/epidemiología , Ciudades/epidemiología , Certificado de Defunción , Femenino , Geografía , Humanos , Clasificación Internacional de Enfermedades , Masculino , Persona de Mediana Edad , Proyectos Piloto , Reproducibilidad de los Resultados , Población Rural , Población Urbana , Adulto Joven
9.
Klin Monbl Augenheilkd ; 236(12): 1413-1417, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31805596

RESUMEN

BACKGROUND: Transformation into a standardised code system such as ICD-10 or Alpha-ID is required before medical reports can be scientifically analysed. This is due to the use of different terminologies and the frequent use of synonyms. The so-called "word vector embedding" seems to be suitable for the generation of the required thesaurus, because synonymous diagnoses can be identified independently of the spelling - after suitable training of the underlying neural network. METHODS: All letters from a total of 50,000 patients were extracted anonymously. Diagnoses consisting of several words were merged into single words by means of phrase recognition and the "word2vec" model was trained on the text corpus of 352 megabytes. A total of 3742 diagnoses and ophthalmological interventions were extracted semi-automatically. The ophthalmological ICD and Alpha-ID codes were downloaded together with the official descriptions from the DIMDI website and the ophthalmological diagnoses/interventions were automatically linked with the nearest ICD- and Alpha-ID codes in the "word2vec" model. RESULTS: The "word2vec" model assigned 90% of the doctor's letter diagnoses correctly to appropriate ICD-10 codes. At the finer level of Alpha-ID, the rate of correct assignments was only 76%. The interventions were assigned to the correct indication in 92% of cases. Rare diseases, unusual designations and code degeneration in the official DIMDI file were identified as sources of error for incorrect or missing allocations. DISCUSSION: A diagnostic thesaurus can be generated with the "word2vec" method from a corpus of anonymised medical reports and the official Alpha-ID file from the DIMDI website. This thesaurus could be used for automatic extraction of diagnoses from doctor's letters in the future, given appropriate manual revision.


Asunto(s)
Clasificación Internacional de Enfermedades , Registro Médico Coordinado , Humanos
10.
Artículo en Ruso | MEDLINE | ID: mdl-31884747

RESUMEN

The article presents the results of analysis of indices of total morbidity of population of the Central Federal Okrug (CFD) of the Russian Federation in 2010-2017. The significant differences in indices of total morbidity between the CFD subjects in certain ICD-10 classes were established. The indices of total morbidity of population during study period (8 years) in the Central Federal District factually didn't altered, while dynamics of indices in other subjects was characterized by multidirectionality. The gap in levels of total morbidity of population in the subjects was significant: from 115,123.6 per 100,000 of population in the Kursk Oblast to 194,404.1 per 100,000 of population in the Orel Oblast. The significant difference in rates of increase/ decrease of indices is noted. Thus, in Moscow decrease rate made up to 10%, while in the Orel Oblast morbidity increased up to 13.1%. Besides, in 2017, the Orel Region took a leadership in rate of increasing of total morbidity in such classes of diseases as infectious and parasitic diseases (39.3%), diseases of blood and blood-forming organs (49.1%), diseases of endocrine system (59,1%), diseases of nervous system (26.8%), diseases of respiratory system (28.2%), diseases of musculoskeletal system (16%), malformations (56%). It is very likely that this trend developed under influence of demographic situation in the subject due to significant increasing of percentage of people older than able-bodied age. The city of Moscow occupies leading position in decreasing of rate of prevalence of diseases and last but one place in level of total morbidity being inferior only to the Kursk Oblast. Thus, in Moscow was noted the most significant decreasing of morbidity in classes of infectious and parasitic diseases (26%) and diseases of digestive system (20.6%). The diseases of blood and blood-forming organs (235.2 per 100,000 population) and mental disorders (2353.5 per 100,000 population) were registered the less. The main contribution into trends of increasing or decreasing of indices is made by persons aged 18 years and older (74.1%).


Asunto(s)
Clasificación Internacional de Enfermedades , Morbilidad/tendencias , Moscú/epidemiología , Prevalencia , Federación de Rusia
11.
Artículo en Ruso | MEDLINE | ID: mdl-31884765

RESUMEN

The statistics of causes of death is the informational basis for identifying public health problems. That is why the accurately accounting for mortality from diabetes mellitus, which is a global medical and social problem for society, is important. The study was carried out to analyze the correctness of coding death causes of diabetes mellitus and the frequency of alleged death. MATERIALS AND METHODS: The Moscow deceased population database of July 2018 - July 2019 was analyzed. Using the decision tables on codes linkages from ICD-10, incorrect codes for underline cause were established for 342 death cases from diabetes mellitus. Among 43044 cases of cardiovascular death the cases of presumed death from diabetes were detected. The analysis was carried out in the Microsoft Access 2007 software. THE RESULTS: In 18.4% of cases, the cause of death from diabetes was encoded incorrectly. If a modification of the underline death cause is assumed due to the mention of certain diseases in any line of the Death Certificate, cases of coding for death from diabetes with wrong fourth character are more often detected when mentioning kidney diseases. If modification of the underline cause is provided for cases when information in the Death Certificate indicates that diabetes has caused the development of some diseases then the largest number of cases with incorrect coding was detected when mentioning circulatory diseases. Only in one medical organization the frequency of incorrect coding is 3.4%, in the rest it varies from 15.4% to 52.2%. Among all death causes, diabetes was only 0.41%. If to add cases of presumptive death from diabetes mellitus, then the proportion of diabetes in the structure of death causes will almost triple and reach up to 1.2%. CONCLUSIONS: The quality of diagnosis and coding of death causes from diabetes has not improved in recent years. To increase it, it is advisable to organize and establish the institution of coders. It is advisable to indicate the presence of diabetes mellitus in the Death Certificate without fail and use the information from the diabetes register. It is proposed to encode the death cause from diabetes mellitus with multiple complications use line D in the Death Certificate to indicate damage to various organs and systems if it is necessary.


Asunto(s)
Causas de Muerte , Certificado de Defunción , Diabetes Mellitus/mortalidad , Humanos , Clasificación Internacional de Enfermedades , Moscú/epidemiología
12.
Artículo en Alemán | MEDLINE | ID: mdl-31720736

RESUMEN

BACKGROUND: The validity of mortality statistics is specific to causes of death and depends on the quality of death certificates. The proportion of noninformative underlying causes of death in all deaths is an indicator for the validity of a mortality statistic. The most frequent noninformative cause of death involves cardiovascular diseases (ICD-10: I00-I99). OBJECTIVES: Regional differences in the frequency and type of use of noninformative cardiovascular causes of death are investigated and their effect on the mortality rate of ischemic heart disease is presented. MATERIALS AND METHODS: Mortality rates for cardiovascular causes of death by gender, age group, and federal state were extracted from the Information System of the Federal Health Monitoring (GBE) for 2000, 2010, 2015, and 2016. The proportion of noninformative causes of death in all cardiovascular deaths, as well as the mortality rate for ischemic heart disease after recoding noninformative causes of death, were calculated. RESULTS: The proportion of noninformative causes of death in all cardiovascular deaths is high and depends on age, sex, federal state, and year of death. Regional differences in frequency and type of use were found. After recoding selected noninformative causes of death, the mean increase in the mortality rate for ischemic heart disease in all federal states was 33%. DISCUSSION: A comparison of cause-specific mortality rates between regions, sexes, and over time is affected by differences in the use of noninformative causes of death. Improving the quality of death certificates is a prerequisite for valid mortality statistics.


Asunto(s)
Enfermedades Cardiovasculares , Isquemia Miocárdica , Causas de Muerte , Alemania , Humanos , Clasificación Internacional de Enfermedades , Mortalidad
14.
Artículo en Alemán | MEDLINE | ID: mdl-31758220

RESUMEN

In the project BURDEN 2020 - "The burden of disease in Germany and its regions" - the years of life lost (YLL) due to premature mortality are calculated on the basis of official cause-of-death statistics. This requires the identification and redistribution of the so-called ill-defined ICD codes. "Ill-defined" means that an ICD code does not sufficiently reflect the cause of death, such that it is not informative for the calculation of the burden of disease.The first steps on the way to calculating cause-specific YLL are presented. Different frameworks of ill-defined codes are compared. The number of deaths with ill-defined codes that can be found in the German cause-of-death statistics in absolute and relative terms are analyzed, including how they are distributed by age, sex, and region.According to the WHO framework, 15.6% of the 925,200 deaths in Germany in 2015 can be identified as ill-defined. According to the framework of the Institute for Health Metrics and Evaluation (IHME) in the Global Burden of Disease Study (GBD), the proportion of ill-defined codes is 26.6%. The ICD-related distribution patterns hardly differ between WHO and IHME classifications. Considerable differences exist between the federal states, with shares of ill-defined codes between 16 and 35% (IHME framework).The cause-of-death statistics in Germany contain a considerable proportion of ill-defined codes. The differences between the federal states can only partially be explained by different electronic data processing. Due to further dissemination and improvement of electronic data collection, higher quality of cause-of-death statistics can be expected in the future.


Asunto(s)
Causas de Muerte , Clasificación Internacional de Enfermedades , Biometría , Recolección de Datos , Alemania
15.
Artículo en Alemán | MEDLINE | ID: mdl-31686151

RESUMEN

About half of all German death certificates are processed electronically by regional statistical offices to select the underlying cause of death in accordance with the instructions from the World Health Organization. This paper illustrates electronic coding and its importance for cause of death statistics.The electronic coding kernel MUSE was added a few years ago to the international coding system Iris, which is maintained by the Iris Core Group.A new module assigns, as far as possible, ICD-10 codes to medical terms documented in death certificates. It takes into account syntactical specifics of the German language. In addition, automatic text correction is implemented. Unrecognised text parts are highlighted and coded manually.Despite these efforts, improvement of data quality is the greatest challenge of German cause-of-death statistics. All involved stakeholders (physicians, local health authorities, and regional statistical offices) can cope with this task by a common effort.The process of electronic coding provides valuable hints for improving the quality of death certificates. In future, the coding system could generate feedback to local health authorities indicating medical documentation problems.


Asunto(s)
Causas de Muerte , Certificado de Defunción , Clasificación Internacional de Enfermedades , Alemania , Humanos , Organización Mundial de la Salud
16.
Adv Exp Med Biol ; 1192: 17-25, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31705488

RESUMEN

Because of the poor link between psychiatric diagnosis and neurobiological findings, it is difficult to classify mental disorders. The changes made to psychiatric diagnostic systems over the years can be understood in terms of "practical conservatism." The Diagnostic and Statistical Manual of Mental Disorders (DSM)-I and DSM-II were theoretically supported by the psychoanalytic and psychodynamic approach. Subsequently, psychiatric diagnoses of this kind were opposed by the anti-psychiatry movement, as well as by the findings of the Rosenhan experiment. Thus, the DSM-III revolution contained more empiricism, aligning psychiatry with biomedicine. Psychiatric diagnoses are classified and defined in terms of Kraepelinian dualism, using a categorical approach. The empirical trend was continued in the DSM-IV. To overcome the limitations of current psychiatric diagnostic systems and integrate fundamental genetic, neurobiological, behavioral, environmental, and experimental components into psychiatry, the Research Domain Criteria (RDoC) were established. To overcome the limitations of the categorical approach, psychiatrists have considered adopting a dimensional approach. However, their efforts were frustrated in the DSM-5 revision process. Thus, the DSM-5 is characterized by the rearrangement of psychiatric diagnoses, the partial adoption of a dimensional approach, the introduction of new diagnoses, and harmonization with the International Classification of Diseases.


Asunto(s)
Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastornos Mentales/clasificación , Trastornos Mentales/psicología , Psiquiatría , Humanos , Clasificación Internacional de Enfermedades , Neurobiología
17.
Aten. prim. (Barc., Ed. impr.) ; 51(9): 579-585, nov. 2019. tab
Artículo en Español | IBECS | ID: ibc-185934

RESUMEN

Presentamos la evolución de la terminología y los criterios diagnósticos para el síndrome de fatiga crónica/encefalomielitis miálgica. Este síndrome es una entidad compleja y controvertida, de etiología desconocida, que aparece en la literatura médica en 1988, si bien desde el siglo XIX se identificaron cuadros clínicos de fatiga crónica idiopática con diferentes nombres, desde neurastenia, neuromiastenia epidémica y encefalomielitis miálgica benigna hasta la actual propuesta de enfermedad de intolerancia al esfuerzo (postesfuerzo). Todos ellos aluden a un estado crónico de fatiga generalizada de naturaleza desconocida, con limitaciones al esfuerzo físico y mental, acompañado de un conjunto de síntomas que comprometen diversos sistemas orgánicos. La Clasificación Internacional de Enfermedades (CIE-10) encuadra este síndrome en el apartado de trastornos neurológicos (G93.3), aunque todavía no se hayan encontrado hallazgos anatomopatológicos que lo clarifiquen. Se han documentado múltiples alteraciones orgánicas, pero no se ha establecido una biología común que aclare los mecanismos que subyacen a esta dolencia. Se enuncia como una disfunción neuroinmunoendocrina, con un diagnóstico exclusivamente clínico y por exclusión. Diversos autores han propuesto incluir el síndrome de fatiga crónica/encefalomielitis miálgica dentro de los síndromes de sensibilidad central, aludiendo a la sensibilización central como el sustrato fisiopatológico común para este síndrome y otros. El papel del médico de familia es clave en la enfermedad, para la detección de aquellos pacientes que presenten una fatiga de naturaleza desconocida que se prolonga de forma continua o intermitente durante más de 6 meses, al objeto de realizar un diagnóstico temprano y establecer un plan de actuación frente a una enfermedad crónica con unos altos niveles de morbilidad en la esfera física y mental. Objetivo: Realizar una revisión bibliográfica de la terminología y criterios diagnósticos del síndrome de fatiga crónica/encefalomielitis miálgica, al objeto de aclarar conceptualmente la enfermedad, como utilidad en el diagnóstico a los médicos de Atención Primaria


Changes in the terminology and diagnostic criteria for chronic fatigue syndrome/myalgic encephalomyelitis are explained in this paper. This syndrome is a complex and controversial entity of unknown origins. It appears in the medical literature in 1988, although clinical pictures of chronic idiopathic fatigue have been identified since the nineteenth century with different names, from neurasthenia, epidemic neuromyasthenia, and benign myalgic encephalomyelitis up to the current proposal of disease of intolerance to effort (post-effort). All of them allude to a chronic state of generalised fatigue of unknown origin, with limitations to physical and mental effort, accompanied by a set of symptoms that compromise diverse organic systems. The International Classification of Diseases (ICD-10) places this syndrome in the section on neurological disorders (G93.3), although histopathological findings have not yet been found to clarify it. Multiple organic alterations have been documented, but a common biology that clarifies the mechanisms underlying this disease has not been established. It is defined as a neuro-immune-endocrine dysfunction, with an exclusively clinical diagnosis and by exclusion. Several authors have proposed to include CFS/ME within central sensitivity syndromes, alluding to central sensitisation as the common pathophysiological substrate for this, and other syndromes. The role of the family doctor is a key figure in the disease, from the detection of those patients who present a fatigue of unknown nature that is continuous or intermittent for more than 6 months, in order to make an early diagnosis and establish a plan of action against a chronic disease with high levels of morbidity in the physical and mental sphere. Objective: To carry out a bibliographic review of the terminology and diagnostic criteria of the chronic fatigue syndrome/myalgic encephalomyelitis, in order to clarify the pathology conceptually, as a usefulness in the diagnosis of Primary Care physicians


Asunto(s)
Humanos , Historia del Siglo XIX , Neurastenia/epidemiología , Neurastenia/historia , Fatiga/diagnóstico , Encefalomielitis/diagnóstico , Terminología como Asunto , Síndrome de Fatiga Crónica/epidemiología , Medicina Familiar y Comunitaria , Síndrome de Fatiga Crónica/historia , Clasificación Internacional de Enfermedades/historia , Diagnóstico Precoz
18.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31570652

RESUMEN

The American Academy of Pediatrics provides this revised policy statement to address health care changes that impact procedural and visit coding and valuation as well as the incorporation of coding principles into innovative, newer payment models. This policy statement focuses solely on recommendations, and an accompanying technical report provides supplemental coding and valuation background.


Asunto(s)
Codificación Clínica , Current Procedural Terminology , Clasificación Internacional de Enfermedades , Pediatría , Escalas de Valor Relativo , Comités Consultivos , Niño , Bases de Datos Factuales , Humanos , Medicaid , Estados Unidos
19.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31570653

RESUMEN

The American Academy of Pediatrics provides this technical report as supplemental background to the accompanying coding and valuation system policy statement. The rapid evolution in health care payment modeling requires that clinicians have a current appreciation of the mechanics of service representation and valuation. The accompanying policy statement provides recommendations relevant to this area, and this technical report provides a format to outline important concepts that allow for effective translation of bedside clinical events into physician payment.


Asunto(s)
Codificación Clínica , Clasificación Internacional de Enfermedades , Pediatría , Escalas de Valor Relativo , Codificación Clínica/legislación & jurisprudencia , Current Procedural Terminology , Health Insurance Portability and Accountability Act , Humanos , Medicare Access and CHIP Reauthorization Act of 2015 , Estados Unidos
20.
Health Serv Res ; 54(6): 1223-1232, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31576566

RESUMEN

OBJECTIVE: To develop and validate a claims-based comorbidity score for patients undergoing major surgery, and compare its performance with established comorbidity scores. DATA SOURCE: Five percent Medicare data from 2007 to 2014. STUDY DESIGN: Retrospective cohort study of patients aged ≥65 years undergoing six major operations (N = 99 250). DATA COLLECTION: One-year mortality was the primary outcome. Secondary outcomes were hospital mortality, 30-day mortality, 30-day readmission, and length of stay. The comorbidity score was developed in the derivation cohort (70 percent sample) using logistic regression model. The comorbidity score was calibrated and validated in the validation cohort (30 percent sample), and compared against the Charlson, Elixhauser, and Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) comorbidity scores using c-statistic, net reclassification improvement, and integrated discrimination improvement. PRINCIPAL FINDINGS: In the validation cohort, the surgery-specific comorbidity score was well calibrated and performed better than the Charlson, Elixhauser, and CMS-HCC comorbidity scores for all outcomes; the performance was comparable to the CMS-HCC for 30-day readmission. For example, the surgery-specific comorbidity score (c-statistic = 0.792; 95% CI, 0.785-0.799) had greater discrimination than the Charlson (c-statistic = 0.747; 95% CI, 0.739-0.755), Elixhauser (c-statistic = 0.747; 95% CI, 0.735-0.755), or CMS-HCC (c-statistic = 0.755; 95% CI, 0.747-0.763) scores in predicting 1-year mortality. The net reclassification improvement and integrated discrimination improvement were greater for surgery-specific comorbidity score compared to the Charlson, Elixhauser, and CMS-HCC scores. CONCLUSIONS: Compared to commonly used comorbidity measures, a surgery-specific comorbidity score better predicted outcomes in the surgical population.


Asunto(s)
Comorbilidad , Guías como Asunto , Mortalidad Hospitalaria , Clasificación Internacional de Enfermedades/normas , Ajuste de Riesgo/normas , Procedimientos Quirúrgicos Operativos/clasificación , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Modelos Logísticos , Masculino , Reproducibilidad de los Resultados , Estudios Retrospectivos , Estados Unidos
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