Factors influencing emergency medical readmission risk in a UK district general hospital: a prospective study.

We recently received a query from a reader of our article [1], about the ICD-10-based definitions used to define the "chronic obstructive pulmonary disease / asthma" group of index admissions. Prompted by the query, we detected an error in the way the definition of this group, as well as the "acute coronary syndrome" group are described in the printed version of our article, which we wish to correct.

The printed version of the article describes chronic obstructive pulmonary disease / asthma as composed of ICD-10 codes J44.0-45.9. This should have read: J40.0-J46 (i.e. diagnostic codes relating to Chronic Obstructive Pulmonary Disease, chronic bronchitis, emphysema and asthma), as well as J12.0-J18 (i.e. diagnostic codes relating to pneumonia). We have included asthma and pneumonia in the definition of this group because, based on experience, we felt that in adults over 50 who are admitted to hospital a primary diagnosis of either asthma or pneumonia is very likely to either represent miscoding of COPD for (asthma or pneumonia), and/or an exacerbation episode of underlying Chronic Obstructive Pulmonary Disease. We include the exact composition of this group, by diagnostic code in Table 1.

Table 1

ICD-10 coding composition of the "chronic obstructive pulmonary disease / asthma" group of index admissions used in the study.

ICD-10 code	Description	Number of index admissions	%
J13X	Pneumonia due to Streptococcus pneumoniae	18	0.6
J14X	Pneumonia due to Haemophilus influenzae	2	0.1
J151	Bacterial pneumonia, not elsewhere classified	3	0.1
J154	Bacterial pneumonia, not elsewhere classified	4	0.1
J157	Bacterial pneumonia, not elsewhere classified	10	0.3
J180	Pneumonia, organism unspecified	53	1.7
J181	Pneumonia, organism unspecified	450	14.8
J182	Pneumonia, organism unspecified	1	0.0
J188	Pneumonia, organism unspecified	1	0.0
J189	Pneumonia, organism unspecified	201	6.6
J42X	Unspecified chronic bronchitis	2	0.1
J439	Emphysema	61	2.0
J440	Other chronic obstructive pulmonary disease	771	25.3
J441	Other chronic obstructive pulmonary disease	632	20.7
J448	Other chronic obstructive pulmonary disease	11	0.4
J449	Other chronic obstructive pulmonary disease	157	5.2
J450	Asthma	1	0.0
J459	Asthma	657	21.6
J46X	Status asthmaticus	12	0.4
Total		3047	100

Similarly, in the printed version of the article the group of "acute coronary syndrome" is defined as I20.0 and I21.0-9. This should have read: I20.0-9 (i.e. angina), I21.0-9 (acute MI) and R07.0-9 (i.e. "non-specific pain in throat or chest"). Again we have decided to include non-specific chest pain along with angina and MI, due to potential for miscoding and/or true co-morbidity (of non-specific chest pain with acute ischaemic heart disease presentations). The exact composition of codes used for the "acute coronary syndrome" group is included in Table 2.

Table 2

ICD-10 coding composition of the "acute coronary syndrome" group of index admissions used in the study.

ICD-10 code	Description	Number of index admissions	%
I200	Unstable angina	367	8.6
I201	Angina pectoris with documented spasm	2	0.0
I208	Other forms of angina pectoris	3	0.1
I209	Angina pectoris, unspecified	721	16.8
I210	Acute transmural myocardial infarction of anterior wall	285	6.7
I211	Acute transmural myocardial infarction of inferior wall	388	9.1
I212	Acute transmural myocardial infarction of other sites	40	0.9
I214	Acute subendocardial myocardial infarction	90	2.1
I219	Acute myocardial infarction, unspecified	363	8.5
R072	Precordial pain	2	0.0
R073	Other chest pain	626	14.6
R074	Chest pain, unspecified	1396	32.6
Total		4283

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-227X/5/4/prepub