Pediatric Complex Chronic Conditions

Introduction

The adult comorbidities defined by authors such as Charlson, Quan and Elixhuaser are not suitable for pediatric research. Feudtner and others produced comorbidity definitions suitable for infants and children, with mappings defined for both ICD-9 and ICD-10 codes [Feinstein et al. (2018); Feudtner_Pediatriccomplexchronic_2014]. These are now included in the icd package for R, which enables fast calculation of comorbidities for PCCC and other ICD code to comorbidity maps.

Calculating PCCC comorbidities.

The PCCC comorbidities may be derived from both diagnostic and procedure codes. The following simulated data has both:

head(dat)
##      id icd_dx1 icd_dx2 icd_pcs1 icd_pcs2
## 1 10001 S32010B T422X3D  0SWJ37Z  00QS4ZZ
## 2 10002    D686     A42  0D124JB  03QB4ZZ
## 3 10003 S32021G   M4806  2W03X6Z  D91497Z
## 4 10004 S61320A T475X6A  03SP4ZZ  0BU207Z
## 5 10005    S054 S90222A  06104ZP  B41D1ZZ
## 6 10006  M12232 V9209XS  0XRL07P  0PUM0JZ

The data is in ‘wide’ format. Currently icd requires it be in ‘long’ format, which can be achieved as follows:

dx <- wide_to_long(dat[1:3])
pcs <- wide_to_long(dat[c(1, 4:5)], icd_name = "pcs", icd_regex = "icd_pcs")
head(dx)
##      id icd_code
## 1 10001  S32010B
## 2 10001  T422X3D
## 3 10002     D686
## 4 10002      A42
## 5 10003  S32021G
## 6 10003    M4806
head(pcs)
##      id      pcs
## 1 10001  0SWJ37Z
## 2 10001  00QS4ZZ
## 3 10002  0D124JB
## 4 10002  03QB4ZZ
## 5 10003  2W03X6Z
## 6 10003  D91497Z

Now the PCCC comorbidity classes can be computed and summarized in a plot:

pccc_dx <- comorbid_pccc_dx(dx)
pccc_pcs <- icd10_comorbid_pccc_pcs(pcs, 
                                    visit_name = "id", icd_name = "pcs")
res <- pccc_dx | pccc_pcs

References

Feinstein, James A., Seth Russell, Peter E. DeWitt, Chris Feudtner, Dingwei Dai, and Tellen D. Bennett. 2018. “R Package for Pediatric Complex Chronic Condition Classification.” JAMA Pediatrics 172 (6): 596–98. https://doi.org/10.1001/jamapediatrics.2018.0256.