Characterization of lBD and lBD Diagnostic Codes in the Elderly
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Background: It is important to validate the use of inflammatory bowel disease (IBD) international classification of diseases (ICD) codes in the hospital discharge abstracts, specifically for the elderly as other colonic diseases (e.g. ischemic colitis) are more common in the elderly and could lead to miscoding. Methods: From the six hospitals in Winnipeg, elderly (>65 years) and young (<50 years) patients discharged with a diagnosis of IBD between April 1, 2007 and March 31, 2010 and a random selection of elderly patients with other colonic conditions were identified and their hospital charts reviewed. Results: 170 elderly and 85 young patients with IBD discharge diagnosis and 135 elderly with other gastrointestinal discharge diagnosis were included. For Crohn's disease (CD), single ICD codes had sensitivity of 98%, specificity 96% and a positive predictive value (PPV) of 94%; for ulcerative colitis (UC) 100%, 86% and 70% respectively. Ileocolonic disease was more common in younger CD patients (58.3%) while elderly patients were more likely to have ileal or colonic disease (p<0.05). The elderly IBD were more likely to be on 5-aminosalicylates prior to hospitalization (61% vs. 43%, p=0.041) while the young IBD were more likely to be prescribed biologics (21% vs. 6%, p=0.016) and immunomodulators (42% vs 21%, p=0.01 ). Conclusions: A single ICD-10 IBD code is satisfactory to identify elderly CD hospitalized patients, and although less accurate, still has good specificity to identify elderly UC patients. Biologicals and immunomodulators are used less often in the elderly IBD, even among those with disease severe enough to require hospitalization.