Many enteric pathogens disproportionately infect children. Hospital discharge data can provide information on severe infections, including cost. However, the diagnosis must be recorded on the discharge record and coded accurately. We estimated the rate of underascertainment in hospital discharge data among children with culture-confirmed Campylobacter, Salmonella, and Escherichia coli O157 infections using linked laboratory and hospital discharge data from an integrated health care organization. We reviewed the International Classification of Diseases, 9th and 10th Revisions, Clinical Modification (ICD-9/10-CM) diagnosis codes on each patient's discharge record. We determined the percentage of patients who had a pathogen-specific diagnosis code (for Campylobacter, Salmonella, or E. coli O157) or nonspecific gastroenteritis code. We included the first admission or positive test and calculated the number of days between specimen submission (outpatient ≤7 days before admission or inpatient) and hospital discharge. Of 65 hospitalized children with culture-confirmed Campylobacter (n = 30), Salmonella (n = 24), or E. coli O157 (n = 11) infections, 55% had that pathogen-specific diagnosis code listed on the discharge record (79% Salmonella, 54% E. coli O157, 37% Campylobacter). The discharge records of the 35 children with a specimen submitted for culture ≥3 days before discharge were 16 times more likely to have a pathogen-specific diagnosis than the records of the 30 children with a specimen submitted <3 days before discharge (83% vs. 23%; odds ratio 15.9, 95% confidence interval: 4.7–53.8). Overall, 34% of records of children with culture-confirmed infection had ≥1 nonspecific gastroenteritis code (Campylobacter 43%, Salmonella 29%, E. coli O157 18%), including 59% of those for children without a pathogen-specific diagnosis (Campylobacter 63%; Salmonella 60%; E. coli O157 40%). This study showed that hospital discharge data under-ascertain enteric illnesses in children even when the infections are culture confirmed, especially for infections that usually have a short length of stay.

中文翻译：

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医院出院数据未确定儿童肠道细菌感染。

许多肠道病原体不成比例地感染儿童。出院数据可以提供有关严重感染的信息，包括费用。但是，诊断必须记录在出院记录上并准确编码。我们使用来自综合医疗保健组织的相关实验室和出院数据，估计了经培养证实的弯曲杆菌、沙门氏菌和大肠杆菌O157 感染儿童的出院数据不确定率。我们在每位患者的出院记录中查看了国际疾病分类第 9 次和第 10 次修订、临床修改 (ICD-9/10-CM) 诊断代码。我们确定了具有病原体特异性诊断代码的患者百分比（对于弯曲杆菌、沙门氏菌或大肠杆菌O157）或非特异性胃肠炎代码。我们包括第一次入院或阳性测试，并计算了标本提交（入院或住院前≤7天的门诊）和出院之间的天数。在 65 名经培养证实为弯曲杆菌( n  = 30)、沙门氏菌( n  = 24) 或大肠杆菌O157 ( n  = 11) 感染的住院儿童中，55% 的出院记录中列出了病原体特异性诊断代码 (79 %沙门氏菌, 54%大肠杆菌O157, 37%弯曲杆菌）。出院前 ≥ 3 天提交培养标本的 35 名儿童的出院记录比出院前 3 天提交标本的 30 名儿童的记录具有病原体特异性诊断的可能性高 16 倍（83% 对. 23%；优势比 15.9，95% 置信区间：4.7–53.8）。总体而言，34% 的培养确诊感染儿童的记录具有≥1 个非特异性胃肠炎代码（弯曲杆菌43%，沙门氏菌29%，大肠杆菌O157 18%），其中 59% 的儿童没有病原体特异性诊断（弯曲杆菌63%；沙门氏菌60%；大肠杆菌O157 40%）。这项研究表明，即使感染得到培养证实，出院数据也不能确定儿童的肠道疾病，特别是对于通常住院时间较短的感染。