Apparent Life-threatening Event (ALTE) ICD 9 Code Proposal：明顯的威脅生命的事件（ALTE）的ICD 9編碼方案

ApparentLife-ThreateningEvent

(ALTE)

ICD-9-CMCodeProposalJackPercelay,MD,MPH,FAAPJeffreyLinzerSr.,MD,FAAPOverviewALTEdefinitionEpidemiologyVariabilityinclinicalapproachNeedforanevidencebasisLimitationsofproxycodesALTEdefined"anepisodethatisfrighteningtotheobserverandischaracterizedbysomecombinationofapnea(centraloroccasionallyobstructive),colorchange(usuallycyanoticorpallidbutoccasionallyerythematousorplethoric),markedchangeinmuscletone(usuallymarkedlimpness),choking,orgagging.”NationalInstitutesofHealth,ConsensusDevelopmentConferenceonInfantileApneaandHomeMonitoring,Sept29toOct1,1986.Pediatrics.1987;79:292–299.WhatarethecausesofanALTE?33-50%:GI(gastroesophagealreflux)15-30%:Neurologic(seizures)11-20%:Respiratory(lowerrespiratorytractinfections)4%:ENT1-5%:CardiacInapproximately25-50%ofcasesnocausecanbeidentifiedKahnA.EurJPediatr(2004)163:108–115McGovernMC,SmithMBH.ArchDisChild(2004)89:1043–1048ApneadoesnotequalALTEApneaupto20secondsoccursin43%ofhealthyterminfantRamanathanR.JAMA(2001)285:2199-2070.2-0.9%ofinfantshaveapnearequiringadmissionMitchellEA.Acta

Paediatr(2001)90:417-22WennergrenG.Acta

Paediatr

Suppl(1993)82(Suppl389):S114-6Kiechl-Kohlendorfer,U.ArchDisChild(2004)90:297-300EvaluationofALTELackofconsensusinapproachrefluxtesting(pHprobestudyorupperGI)sleepstudyEEGECGheadCTchestx-raylumbarpuncturemedicationsforpresumedinfectionorGERTiederJS.JPediatr(2008)152:629-35CosttoUSHealthcareSystemTieder’sstudyof12,067patientsadmittedforALTEshowedMeanlengthofstayof4.4days(±5.6days)Meanadjustedchargesof$15,567(±$28,510)peradmissionMeanin-hospitalmortalityratewas0.56%30-dayreadmissionratewas2.5%Actually,we’renotsureoftheimpactonthehealthcaresystemBecausethereisnouniquecodeforALTETieder’sstudypopulationhadatleast1ofthefollowingdiagnoses:apnea(786.03)respiratoryproblemofthenewborn(770.8)syncope(780.2)alteredconsciousness(780.09)transientlossofconsciousness(780.02)cyanosis(782.5)ALTEisnotasinglesymptomThetermdescribesaclinicalsyndromeCanoccurduringsleep,wakefulness,orfeedingininfantswhoaregenerally>37weeksgestationalageatthetimeofonsetPresentswithacombinationofsymptomsALTEiscurrentlytrackedbasedonthepresentingsymptomsApneanewborn770.81apnea786.03central327.21obstructive327.23Changeinmuscletonemuscleweakness728.87othermyopathies359.89othersymptomsinvolvingnervousandmusculoskeletalsystems781.99Colorchangenewborncyanosis770.83cyanosis782.5newbornplethora776.4plethora782.62Chokingorgaggingchokingsensation784.99chokingduetophlegm933.1WhyisitimportanttobeabletospecificallytrackALTE?InfantswithALTEhaveagreaterriskofsuddendeathcomparedtoinfantsonlypresentingwithapneaand/orbradycardiaTheywillmorelikelybenefitfromahomeapnea/bradycardiamonitorCommitteeonFetusandNewborn,AmericanAcademyofPediatrics.Pediatrics(2003)111(4Pt1):914-7AHRQguidelineforALTE(http:///summary/summary.aspx?doc_id=3732&nbr=002958&string=alte)WithoutauniqueICD-9-CMcodeWeareunable:totracktrueincidencemonitoractualhealthcareimpactperformadequateresearchUKhadanICD-9codeforALTE-798.4AnewICD-9-CMcodeforALTEBasedonthewealthofinternationalliteratu