a classification of diabetic foot infections using icd-9-cm codes application to a large computerized medical database糖尿病足感染的分类使用icd-9-cm编码应用到大型计算机医学数据库.pdfVIP

Fincke et al. BMC Health Services Research 2010, 10:192 /1472-6963/10/192 RESEARCH ARTICLE Open Access A classification of diabetic foot infections using ICD-9-CM codes: application to a large computerized medical database Benjamin G Fincke1,2*, Donald R Miller1,2, Robin Turpin3,4 Abstract Background: Diabetic foot infections are common, serious, and varied. Diagnostic and treatment strategies are correspondingly diverse. It is unclear how patients are managed in actual practice and how outcomes might be improved. Clarification will require study of large numbers of patients, such as are available in medical databases. We have developed and evaluated a system for identifying and classifying diabetic foot infections that can be used for this purpose. Methods: We used the (VA) Diabetes Epidemiology Cohorts (DEpiC) database to conduct a retrospective observational study of patients with diabetic foot infections. DEpiC contains computerized VA and Medicare patient-level data for patients with diabetes since 1998. We determined which ICD-9-CM codes served to identify patients with different types of diabetic foot infections and ranked them in declining order of severity: Gangrene, Osteomyelitis, Ulcer, Foot cellulitis/abscess, Toe cellulitis/abscess, Paronychia. We evaluated our classification by examining its relationship to patient characteristics, diagnostic procedures, treatments given, and medical outcomes. Results: There were 61,007 patients with foot infections, of which 42,063 were classifiable into one of our predefined groups. The different types of infection were related to expected patient characteristics, diagnostic procedures, treatments, and outcomes. Our severity ranking showed a monotonic relationship to hospital length of stay, amputation rate, transition to long-term care, and mortality. Concl