SHM Converge Scientific Abstract ePoster Gallery-Administrative Coding vs Laboratory Diagnosis of Inpatient Hypoglycemia

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This retrospective study examined how well inpatient hypoglycemia is captured by discharge diagnosis codes in a Veterans Affairs hospital. The authors reviewed adults admitted from 2016–2022 with an ICD-10 diabetes diagnosis and compared hypoglycemia diagnosis codes with laboratory glucose values.<br /><br />Hypoglycemia was defined by laboratory results as glucose <70 mg/dL, with severe hypoglycemia defined as <54 mg/dL. Diagnosis codes included common ICD-10 hypoglycemia codes such as E08.64, E10.64, E11.64, E15, and E16.x.<br /><br />The study found that diagnosis codes missed most inpatient hypoglycemic events. Sensitivity of the codes was only 28.7% for laboratory hypoglycemia and 43.5% for severe laboratory hypoglycemia. In other words, many patients with low glucose values did not receive a corresponding discharge diagnosis code. When laboratory data were included, the number of identified hypoglycemic patients increased by 125.7% compared with diagnosis codes alone.<br /><br />Patients with laboratory hypoglycemia tended to be older, predominantly male, and had higher rates of kidney disease, heart failure, insulin use, and inpatient insulin administration than patients without documented lab hypoglycemia.<br /><br />The authors conclude that inpatient diagnosis codes substantially underestimate true hypoglycemia rates. For quality improvement and research, monitoring should use both administrative coding and laboratory glucose data rather than relying on diagnosis codes alone.

Asset Subtitle

Robert J. Gallo

Meta Tag

Author List Daniel Z. Fang, Paul A. Heidenreich, Robert J. Gallo

Category Research

Concept Inpatient Hypoglycemia Diagnosis Codes

Concept Laboratory Glucose Measurement

Concept Hypoglycemia

Concept Under-Recognition

Concept Glucose Threshold

Distinguished Non-Finalist

Presenter Organization Stanford University

Presenting Author Robert J. Gallo

Track Patient Safety

Keywords

inpatient hypoglycemia

ICD-10 diagnosis codes

laboratory glucose values

Veterans Affairs hospital

retrospective study

sensitivity analysis

severe hypoglycemia

diabetes hospitalization

quality improvement

administrative coding

Inpatient Hypoglycemia Diagnosis Codes

Laboratory Glucose Measurement

Hypoglycemia

Under-Recognition

Glucose Threshold