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RSV diagnosis via PCR did not match ICD-9 diagnosis codes
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Recent data show respiratory syncytial virus diagnosis by ICD-9 codes did not correlate with diagnosis by PCR testing, which could skew assessments of RSV burden.
Doris Makari, MD, of AstraZeneca in Gaithersburg, Md., and colleagues analyzed data from a previous prospective, active-surveillance study of respiratory syncytial virus (RSV) among infants younger than 12 months who presented to the ED with lower respiratory tract illness (LRI) or apnea during two RSV seasons. Data were from 31 sites in 23 US states in season 1 and from 27 sites in 20 states in season 2. Nasal swab samples for reverse transcription polymerase chain reaction (RT-PCR) were collected each season during three surveillance periods: peak RSV season (January 15 to February 15) and two shoulder seasons outside the traditional RSV period, defined as Sept. 1 to Oct. 31 and April 1 to May 31. Discharge ICD-9 codes were indicated by medical records.
PCR results were available for 1,100 and 3,070 infants during peak and shoulder seasons, respectively. Sixty-two percent of infants tested positive for RSV by RT-PCR during the peak seasons and 20% tested positive during shoulder seasons. Eighty-seven percent of infants with RSV-specific ICD-9 diagnoses had positive RT-PCR results for RSV.
At least 10 infants had non-RSV-specific ICD-9 diagnoses. Of these, RSV positivity via RT-PCR was highest during the peak seasons among infants with otitis media, acute bronchiolitis, and acute bronchiolitis due to other infectious organisms. Across peak and shoulder seasons combined, ICD-9 discharges for acute bronchiolitis and acute bronchiolitis due to other infectious organisms had the highest RSV positivity.
Thirty-five percent of infants with RT-PCR-confirmed RSV during peak seasons had RSV-specific ICD-9 diagnosis at discharge. Twenty-five percent of infants with RT-PCR-confirmed RSV during shoulder seasons had RSV-specific ICD-9 diagnosis. The most common ICD-9 codes assigned to infants with RT-PCR-confirmed RSV during peak seasons were acute bronchiolitis due to other infectious organisms and acute bronchiolitis due to RSV.
“In this study, RSV diagnosis by RSV-specific ICD-9 code did not correlate well with RSV positivity as diagnosed by PCR. This underscores the need for accurate and timely PCR testing being made more widely available. More widespread use of PCR has the potential of allowing us to gain a more accurate assessment of the true burden of RSV disease,” the researchers concluded.
Disclosure: The study was sponsored by MedImmune. Some of the researchers have financial ties with AstraZeneca, MedImmune, GlaxoSmithKline, and Merck.
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