Charlson Comorbidities in ICD10 codes: Difference between revisions

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== Details with Explanation ==

*The original description by Charlson of what has become the Charlson Comorbidity Index [CCI] (''J. Chr. Dis.'' 40(5):373-383, 1987) was oriented towards identifying the cumulative burden of pre-existing medical conditions for the purpose of taking account of comorbid conditions that might alter mortality in longitudinal research studies. She identified, by manual chart review, a set of 17 conditions to which were applied weights, resulting in a composite "Charlson Score". Furthermore, in her original schema, these weights were modified by age. She found that in a survival analysis of time to death among people with breast cancer, that this comorbidity index was a significant predictor of the hazard of death.

**The 17 conditions are: Myocardial infarction; Congestive heart failure; Peripheral vascular disease; Cerebrovascular disease; Dementia; Chronic pulmonary disease; Rheumatic disease; Peptic ulcer disease; Mild liver disease; Moderate or severe liver disease; Diabetes without chronic complications; Diabetes with chronic complications; Hemiplegia or paraplegia; Renal disease; Any malignancy, including lymphoma and leukemia, except of skin; Metastatic solid tumor; AIDS. Some notes about these 17 conditions:

***Identifying them from chart review requires interpretation -- i.e. it's not always a "slam-dunk". For example, WHICH complications of diabetes should be included? Another example is how should we decide if the liver disease is severe or not? None of these questions of interpretation were defined in Charlson's original formulation.

***Note that these are not all mutually exclusive: e.g. if somebody has DM with chronic complications

*One might ask whether it's reasonable to include only 17 (or 31 or 100 for that matter) specific disorders in trying to measure the cumulative comorbid burden. After all, there are 16,000 ICD-10 codes and the vast majority of them ''can'' be pre-existing conditions. The issue here is that there's clearly a balance here between: (i) being practical in not including too many conditions while still maintaining generalizable results, and (ii) including enough conditions that the resulting measure is still meaningful.

*Despite the original purpose of the CCI, it started being used as a measure of the cumulative burden of comorbid illness in a wide variety of purposes. The next big step was taken by Deyo (''J. Clin. Epidemiol.'' 45(6):613-619, 1992) who in created a set of ICD-9 codes for using administrative health data (hospital abstracts) to calculate the CCI. And this is WITHOUT the age-related portion of the original description by Charlson herself.

*The most recent seminal paper was a modified version of Deyo's coding by Quan (''Medical Care'' 43(11):1130-1139, 2005) who created sets of ICD-9 and ICD-10 codes for CCI (and also, by the way for a different schema by Elixhauser et al for identifying 31 specific comorbid conditions to assess the cumulative burden of comorbid disease).

*The most recent seminal paper was a modified version of Deyo's coding by Quan (''Medical Care'' 43(11):1130-1139, 2005) who created sets of ICD-9 and ICD-10 codes for CCI (and also, by the way for a different schema by Elixhauser ''et al.'' for identifying 31 specific comorbid conditions to assess the cumulative burden of comorbid disease).

**The 17 CCI conditions

Quan assessed the ability of these different coding schemas to predict in-hospital mortality.

**Of great importance to interpretation of the CCI (and the Elixhauser schema too), Quan looked separately at the predictive ability of

*In the time since then the CCI has been widely used

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See '''[[Charlson Comorbidity scoring in ICD10 codes]]''' for more info.

See [[#How this page works]] for info on how these codes are stored on the wiki.

== Listing of ICD10 comorbid codes ==

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 == Details with Explanation ==
 *The original description by Charlson of what has become the Charlson Comorbidity Index [CCI] (''J. Chr. Dis.'' 40(5):373-383, 1987) was oriented towards identifying the cumulative burden of pre-existing medical conditions for the purpose of taking account of comorbid conditions that might alter mortality in longitudinal research studies.  She identified, by manual chart review, a set of 17 conditions to which were applied weights, resulting in a composite "Charlson Score".  Furthermore, in her original schema, these weights were modified by age. She found that in a survival analysis of time to death among people with breast cancer, that this comorbidity index was a significant predictor of the hazard of death.
+**The 17 conditions are:  Myocardial infarction; Congestive heart failure; Peripheral vascular disease; Cerebrovascular disease; Dementia; Chronic pulmonary disease; Rheumatic disease; Peptic ulcer disease; Mild liver disease; Moderate or severe liver disease; Diabetes without chronic complications; Diabetes with chronic complications; Hemiplegia or paraplegia; Renal disease; Any malignancy, including lymphoma and leukemia, except of skin; Metastatic solid tumor; AIDS.  Some notes about these 17 conditions:
+***Identifying them from chart review requires interpretation -- i.e. it's not always a "slam-dunk".  For example, WHICH complications of diabetes should be included?  Another example is how should we decide if the liver disease is severe or not?  None of these questions of interpretation were defined in Charlson's original formulation.
+***Note that these are not all mutually exclusive:  e.g. if somebody has DM with chronic complications
 *One might ask whether it's reasonable to include only 17 (or 31 or 100 for that matter) specific disorders in trying to measure the cumulative comorbid burden.  After all, there are 16,000 ICD-10 codes and the vast majority of them ''can'' be pre-existing conditions.  The issue here is that there's clearly a balance here between: (i) being practical in not including too many conditions while still maintaining generalizable results, and (ii) including enough conditions that the resulting measure is still meaningful.
 *Despite the original purpose of the CCI, it started being used as a measure of the cumulative burden of comorbid illness in a wide variety of purposes.  The next big step was taken by Deyo (''J. Clin. Epidemiol.'' 45(6):613-619, 1992) who in created a set of ICD-9 codes for using administrative health data (hospital abstracts) to calculate the CCI. And this is WITHOUT the age-related portion of the original description by Charlson herself.
-*The most recent seminal paper was a modified version of Deyo's coding by Quan (''Medical Care'' 43(11):1130-1139, 2005) who created sets of ICD-9 and ICD-10 codes for CCI (and also, by the way for a different schema by Elixhauser et al for identifying 31 specific comorbid conditions to assess the cumulative burden of comorbid disease).
+*The most recent seminal paper was a modified version of Deyo's coding by Quan (''Medical Care'' 43(11):1130-1139, 2005) who created sets of ICD-9 and ICD-10 codes for CCI (and also, by the way for a different schema by Elixhauser ''et al.'' for identifying 31 specific comorbid conditions to assess the cumulative burden of comorbid disease).
+**The 17 CCI conditions
+Quan assessed the ability of these different coding schemas to predict in-hospital mortality.
+**Of great importance to interpretation of the CCI (and the Elixhauser schema too), Quan looked separately at the predictive ability of
 *In the time since then the CCI has been widely used
@@ Line 18: / Line 27: @@
 See '''[[Charlson Comorbidity scoring in ICD10 codes]]''' for more info.
 See [[#How this page works]] for info on how these codes are stored on the wiki.
 == Listing of ICD10 comorbid codes ==