Utilising multiple discharge coding will improve identification of patients with giant cell arteritis: a retrospective analysis of a hospital discharge dataset.

Abstract

To determine whether the discharge diagnosis codes used within tertiary hospitals accurately identified patients with Giant Cell Arteritis (GCA), as determined by expert opinion at 6 months. The study was performed across three major hospitals within Perth, Western Australia. Patients with an International Classification of Diseases (ICD) code for GCA (M31.5 and M31.6) at discharge on first inpatient presentation were identified. Review of case notes, discharge summaries, letters, pathology, and imaging results were undertaken. The percentage of patients with an ICD code for GCA at initial discharge with confirmed GCA by expert opinion at 6 months (as the anchor diagnosis) was calculated. As validation of the anchor diagnosis, the percentage who fulfilled the 2022 ACR/EULAR criteria was also calculated, the number of hospital discharges per patient with an ICD code for GCA was calculated, to determine if multiple discharges with an ICD code for GCA increased the specificity of the ICD coding. 93 out of 157 admissions with an ICD for GCA were identified as a first inpatient presentation. At 6 months follow up, 65.6%, 95 CI [55.0%, 75.1%] had confirmed GCA by expert opinion. 88.2%, 95 CI [79.8%, 93.9%] met the 2022 ACR/EULAR criteria for GCA. The specificity of the ICD coding increased with increasing number of discharges- 67.4% with single episode, 80% with two episodes, and 100% with three or more episodes (p = 0.1373). Only 43.8%, 95 CI [26.4%, 62.3%] of patients who did not have GCA had an alternative diagnosis provided. 31.3%, 95 CI [16.1%, 50.0%] of patients who did not have GCA still have the GCA diagnosis listed in their subsequent clinical records and discharge summaries. Only 2/3rds of those patients with an initial discharge ICD code for GCA were found to have confirmed GCA at follow-up. This poor correlation between the ICD coding and confirmed diagnosis of GCA will impact the quality of data extracted from administrative health datasets for epidemiological and longitudinal studies. Selecting patients with two or more GCA coded episodes could improve the homogeneity of the cohort for recruitment into GCA studies, but a larger sample size study is required.