ICD-11: Classification & Coding of Allergic Conditions, Study notes of Construction

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REPRESENTATION OF ALLERGIC

AND RELATED CONDITIONS IN

THE ICD-

Luciana Kase Tanno

Pascal Demoly

WICC Annual Meeting

Lyon, France

th

Aug – 1

st

Sept

Allergy, allergies…

MISCLASSIFICATION OF ALLERGIC AND

HYPERSENSITIVITY CONDITIONS UNDER THE ICD-

SKIN AND

MUCOUS

ALLERGIES

UPPER

AIRWAY

ALLERGIES

LOWER

AIRWAYS

ALLERGIES

OCCULAR

ALLERGIES

GASTROINTESTINAL

ALLERGIES

VII Diseases of the

eye and adnexa

X Diseases of

the

respiratory

system

XII Diseases

of the skin

and

subcutaneous

tissue

XI Diseases of the

digestive system

Ø ANAPHYLAXIS

Ø DRUG HYPERSENSITIVITY

Ø FOOD HYPERSENSITIVITY

Ø INSECT HYPERSENSITIVITY

• 7937 e-mails sent, 612 responses

AMRO: 83 AFRO: 12

EMRO: 35

SEARO: 27

WPRO: 30

EURO: 405

Main

Conclusions:

• ICD-10: most

frequent

classification

in use

• NOT enough

accurate or

easy to use

Allergy 2014; 69: 559– 570

THE NEW ALLERGIC AND HYPERSENSITIVITY

CONDITIONS SECTION

The example of anaphylaxis

MISCLASSIFICATION OF ANAPHYLAXIS IN ICD-

 Anaphylaxis deaths are under-notified: Tanno et al. Allergy 2012 (research pioneer paper)

The only reference for

food allergy

The ICD-10 elects just severe

cases of anaphylaxis

• Misclassifica on
• Unawareness of Hypersensi vity/

allergy concepts

GLOBAL AVAILABILITY OF AUTO-INJECTABLE

ADRENALINE: A MATTER OF LIFE OR DEATH

Tanno et al. CEA 2017

DECREASING THE UNDER-NOTIFICATION OF ANAPHYLAXIS DEATHS IN BRAZIL

THROUGH THE INTERNATIONAL CLASSIFICATION OF DISEASES (ICD)-11 REVISION

Brazilian Mortality Information System (SIM), data extracted May 2011

Total 3 , 296 , 247 records, from 2008 to 2010

2012 analysis ( Allergy, 2012 ), based on ICD- 10 ( 2010 version) 22012

“Possible anaphylaxis deaths” N = 128

“Definitive anaphylaxis deaths” N = 370

3 , 638 deaths had any ICD- 10 code related to anaphylaxis listed as

the underlying or as contributing causes of death

2016 analysis, based on ICD- 11 Beta Draft (March 2016 version) 22012

“Possible anaphylaxis deaths” (Ma nual review of all codes recorded on any lines parts 1 of the death certificates)

“ Definitive anaphylaxis deaths ” (Specific anaphylaxis codes – T7 80, T782, T805 and T as contributing cause of death)

“ Definitive anaphylaxis deaths ” (Specific anaphylaxis codes as contributing cause of death + Manual review of each description in death certificates)

“Possible anaphylaxis deaths” (Manual review of each description in death certificates: iso lated description of allergic or hypersensitivity clinical presentations described as contributing cause of death)

“Possible anaphylaxis deaths” N = 33

“Definitive anaphylaxis deaths” N = 606

Tanno et al., Allergy 2017

128

370

33

606

Possible anaphylaxis deaths

Definitive anaphylaxis deaths

2012 (ICD-10)

2016 (ICD-11)

 Sensitivity : identification

of cases 25% higher

 Accuracy :

reaching 95% for definitive

anaphylaxis deaths

Supporting the transition…

SUPPORTING THE VALIDATION OF THE NEW ALLERGIC AND

HYPERSENSITIVITY CONDITIONS SECTION OF THE WHO ICD-

ALLERGIC AND HYPERSENSITIVITY

CONDITIONS IN ICD-

( version 2016 WHO website, access April 2016 )

ALLERGIC AND HYPERSENSITIVITY

CONDITIONS CHAPTER IN ICD-

( Linearization ICD-11 Beta draft, access April 2016 )

• 125 conditions
• 6 chapters

Tanno et al., APAJ 2016

Anaphylaxis morbidity data from the

ICD-11 perspective

• Montpellier population: 270,000 inhabitants
• Total number of hospitalization/year : 40,
• Total number of hospitalizations due to allergic and hypersensitivity

conditions/year : 2,318 (6%)

• Anaphylaxis cases/year (2014): 89 cases

Tanno et al., Allergy 2017

 Classification/coding procedures (Kappa value: 0.63)

 Sensible enough (Kappa value: 0,73)

- Under-notification of

morbidity and mortality due

to ICD-10 and ICD-

- Surveying the allergist

community

- Constructing a

classification proposal

**- Mapping procedure

• Collaboration with WHO**

ICD

- Construction of the

“Allergy and Hypersensitivity

conditions” section into the

ICD-

- Support the

validation/transition process

- Keep updating/ working in

ICD-11 platform

**- Dissemination process

• Educational program**

DIRECT IMPACT:

★ Clinical diagnosis and

management

★ Prevention

★ Support Public Health

decision-making: accurate

morbidity and mortality data

- Quality assurance

testing

- ICD-11 platform

stability, feasibility and

translation

- Estimate economic

impact of move

**- Adapt the ICHI

• Discuss the involvement**

in the ICPC and ICF

**- Dissemination

• Education program**

The ALLERGY IN ICD-11 initiative

NEXT STEPS IN THE ICD-11 REVISION

EXPECTED OUTCOMES:

• Strengthen AWARENESS of current concepts
• HEALTH CLINICAL MEDICINE
  • Ensure quality management of allergic patients
  • Support research in the field
• PUBLIC HEALTH
  • Reliable epidemiological data (morbidity/mortality) - decision-making and prevention
  • Appropriate allocation of resources
• Support ALLERGY specialty

PREVIOUS

STEPS

WORKING IN

PROCESS NEXT STEPS

 Academic/scientific process : 21 peer-review publications, 20 ongoing

 Communication and collaboration : Joint Allergy Academies, TAGs/RSG,

Patients’ organization, Junior Members (^) Tanno et al., Ann AAI 2017, adapted