Objective: To explore the extent to which the severity of birth defects could be differentiated using severity of illness (SOI) and risk of mortality (ROM) measures available in national discharge databases.
Methods: Data from the 2012-14 National Inpatient Sample (NIS) was used to identify hospitalizations with one or more major birth defects reported annually to the National Birth Defects Prevention Network using the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnosis codes. Each hospitalization also contained a 4-level SOI and 4-level ROM classification measure. For each birth defect and for each individual birth defect-related ICD-9-CM code, we calculated mean and median SOI and ROM, the proportion of hospitalizations in each level of SOI and ROM, the inpatient mortality rate, and level of agreement between various existing or derived severity proxies in the NIS and the Texas Birth Defects Registry (TBDR).
Results: Mean SOI ranged from 1.5 (cleft lip alone) to 3.7 (single ventricle), and mean ROM ranged from 1.1 (cleft lip alone) to 3.9 (anencephaly). As a group, critical congenital heart defects had the highest average number of co-occurring defects, mean SOI, and ROM, whereas orofacial and genitourinary defects had the lowest SOI and ROM. We found strong levels of agreement between TBDR severity classifications and NIS severity classifications defined using Level 3 or 4 SOI or ROM Level 3 or 4.
Conclusions: This preliminary investigation demonstrated how severity indices of birth defects could be differentiated and compared to a severity algorithm of an existing surveillance program.
Keywords: birth defects; risk of mortality; severity measures.
© 2019 Wiley Periodicals, Inc.
Validation of the All Patient Refined Diagnosis Related Group (APR-DRG) Risk of Mortality and Severity of Illness Modifiers as a Measure of Perioperative Risk.J Med Syst. 2018 Mar 22;42(5):81. doi: 10.1007/s10916-018-0936-3. J Med Syst. 2018. PMID: 29564554 Free PMC article.
Evaluating the impact of expanding the number of diagnosis codes reported in inpatient discharge databases on the counts and rates of birth defects.J Am Med Inform Assoc. 2018 Nov 1;25(11):1524-1533. doi: 10.1093/jamia/ocy096. J Am Med Inform Assoc. 2018. PMID: 30124843
Roles of disease severity and post-discharge outpatient visits as predictors of hospital readmissions.BMC Health Serv Res. 2016 Oct 10;16(1):564. doi: 10.1186/s12913-016-1814-7. BMC Health Serv Res. 2016. PMID: 27724889 Free PMC article.
ICD-10-based expanded code set for use in cleft lip/palate research and surveillance.Birth Defects Res A Clin Mol Teratol. 2016 Nov;106(11):905-914. doi: 10.1002/bdra.23544. Birth Defects Res A Clin Mol Teratol. 2016. PMID: 27891780 Review.
Performance of International Classification of Diseases-based injury severity measures used to predict in-hospital mortality: A systematic review and meta-analysis.J Trauma Acute Care Surg. 2016 Mar;80(3):419-26. doi: 10.1097/TA.0000000000000944. J Trauma Acute Care Surg. 2016. PMID: 26713976 Review.
- 3M Science Applied to Life. (2016). 3M all patient refined diagnosis related groups (APR DRGs). Retrieved from https://www.forwardhealth.wi.gov/kw/pdf/handouts/3M_APR_DRG_Presentation.pdf
- Arth, A. C., Tinker, S. C., Simeone, R. M., Ailes, E. C., Cragan, J. D., & Grosse, S. D. (2017). Inpatient hospitalization costs associated with birth defects among persons of all ages--United States, 2013. MMWR. Morbidity and Mortality Weekly Report, 66(2), 41-46. https://doi.org/10.15585/mmwr.mm6602a1
- Catterall, A. (1991). A method of assessment of the clubfoot deformity. Clinical Orthopaedics and Related Research®, 264, 48-53.
- Centers for Disease Control and Prevention. (2008). Update on overall prevalence of major birth defects--Atlanta, Georgia, 1978-2005. MMWR. Morbidity and Mortality Weekly Report, 57(1), 1-5.
- Centers for Disease Control and Prevention. (2017). Birth defects research and tracking. Retrieved from https://www.cdc.gov/ncbddd/birthdefects/research.html