Showing posts with label ICD-10. Show all posts
Showing posts with label ICD-10. Show all posts

Thursday, June 26, 2014

Acute Concussion Symptom Severity and Delayed Symptom Resolution

Pediatrics Editorial Board Member, Stephen Harris MD, MS, shares his expert perspective on a new article from our July issue. To learn more about Dr. Harris and his work in pediatric medicine, check out our Contributors page.

By: Stephen Harris, MD, MS

child wearing helmet
Photo by Abhisek Sarda via Flickr
During pediatric residency, I used to wear a button that said “I could’a been a brain surgeon,” just to tick off the neurosurgeons. Had I only rested my brain after getting my “bell rung” during my high school hockey days, who knows? Emergency department physicians and those who provide medical care for children now have a variety of practice guidelines, management tools and questionnaires readily available to determine the severity of a concussion, track a patient’s recovery and titrate a slow and safe return to physical and cognitive activities.

Grubenhoff and colleagues, writing in the July issue of Pediatrics (doi: 10.1542/peds.2013-2988), note that 630,000 children 0 to 19 years old visit US emergency departments (ED) for concussion. Citing the evidence that the risk of persistent symptoms may be modifiable, they hypothesized that an elevated symptom score on standardized evaluation at presentation would predict an increased risk of delayed symptom resolution.

Despite careful analysis of a well conducted study, Grubenhoff’s group did not find a target score that was statistically significantly associated with delayed symptom resolution. The authors explain that other studies have shown initial acuity predicts early symptoms, but complex, pre-existing psychological factors come into play to help explain who suffers from prolonged symptoms.

In a secondary analysis, Grubenhoff’s group did find a target score that predicted a higher risk of post-concussive syndrome as defined in the new ICD-10 system. They highlight some similarities between ICD-10 and the clinical criteria they used for delayed symptom resolution, but point out that the diagnostic accuracy of the ICD-10 criteria “is a topic of scientific debate as it is both subjective and imprecise.”

The authors’ call for those working in this research area to refine the definition of post-concussive syndrome should be heeded.

Grubenhoff and colleague’s work supports a continued conservative trajectory in the management of concussion. We now have a more full awareness of the increased risk of cerebral hemorrhage following a “second hit” to the head before one has completely recovered from a concussion—for children or adolescents. We also have an enormous and growing literature on the long-term neurologic and psychiatric consequences that may face those who participate in professional sports where one objective is to savage your opponent.

At the end of the day, any patient suffering a concussion should have close outpatient follow-up and serial symptom assessment following ED discharge.

Related Reading:

Wednesday, June 4, 2014

Although ICD-10 Is Delayed, Pediatric Challenges Loom

By: Lewis First, MD, MS

There has been a lot of concern paid recently within the medical profession to the proposed implementation of the new ICD-10 diagnostic codes—enough to cause a delay in their implementation from this fall to later in 2015.

Photo by re_birf via Flickr
Yet despite the delay, the implications of these new codes for pediatricians remain somewhat unknown, prompting Caskey et al. (doi: 10.1542/ peds.2013-4147) to study what these new codes might mean in terms of clinical information gained or lost as well as fiscal ramifications. The authors used a statewide dataset of Illinois Medicaid patients and looked at over 2,700 ICD-9 codes to see how they were translated into ICD-10 codes as well as what the proposed changes in reimbursement might be for the new codes if put into place. They looked at codes for consistency of uniqueness of information between the two coding systems. Sadly, the authors discover opportunities for administrative coding errors enough to result in what might be a reduction in possible reimbursement payments for work done due to information lost in how the ICD-9 gets recoded in ICD-10.

To help you better understand what ICD-10 might mean for you, we are including a commentary by Fiks and Grundmeier (doi: 10.1542/peds.2014-0726) that sheds additional light on this issue. Before ICD-10 goes live, this study and commentary are must-reads to help prepare you and your practice to understand how to code better for more accurate measurement of quality, clinical outcomes and billing purposes using this new coding system.

Are you ready for ICD-10? Do you agree with the results in this study?  Share your thoughts with us via a response below, an eLetter, or on Facebook and Twitter.

Related Reading: