Hyponatremia and Central Pontine Myelinolysis

What is hyponatremia? Information regarding CPM and EPM.

Archive for the tag “International Statistical Classification of Diseases and Related Health Problems”

CPM: THE STATISTICS

So after months of trying to find out the answers to this question, I have found a beginning answer. Now, here’s the thing. This is the diagnosis code for CPM, but it doesn’t include a diagnosis code for those who develop EPM only…at least I don’t believe it does. But, it’s a start. ūüôā

First the ICD-9 diagnosis code for CPM is

The way I found this is through my friend Jeffery Amitin. He left it in a message he posted in 2008. The ICD-10 code is G37.2:

2012 ICD-10-CM Diagnosis Code G37.2

Central pontine myelinolysis

  • G37.2¬†is a billable ICD-10-CM code that can be used to specify a diagnosis.
  • On October 1, 2013 ICD-10-CM will replace ICD-9-CM in the United States, therefore,¬†G37.2¬†and all ICD-10-CM diagnosis codes should only be used for training or planning purposes until then.

Mortality Data

  • Between 1999-2007 there were 209 deaths in the United States where ICD-10¬†G37.2¬†was indicated as the underlying cause of death¬†
  • ICD-10¬†G37.2¬†as underlying cause of death data broken down by: gender, age, race, year

ICD-10-CM G37.2 is part of Diagnostic Related Group(s) (MS-DRG v28.0):

  • 058¬†Multiple sclerosis & cerebellar ataxia with mcc
  • 059¬†Multiple sclerosis & cerebellar ataxia with cc
  • 060¬†Multiple sclerosis & cerebellar ataxia without cc/mcc

Convert ICD-10-CM G37.2 to ICD-9-CM

The following ICD-10-CM Index entries contain back-references to ICD-10-CM G37.2:

  • Myelinolysis, pontine, central¬†G37.2

Now, the above information states that the number of deaths related to CPM from 1999 to 2007 were 209 deaths. Now, I believe this is an EXTREMELY low number because it is believed that at least a 1/3 of patients who develop CPM die. The following information for 2010 ALONE, makes me doubt that the number of deaths related to CPM over an 8 year period is only 209.

2010 National statistics – principal diagnosis only

Outcomes by 341.8 Cns Demyelination Nec
341.8 Cns Demyelination Nec Standard errors
Total number of discharges 524 56
In-hospital deaths * *

The above information states that there were 524 DISCHARGES related to CPM…that doesn’t include the number of those who died from CPM.

The other interesting finding in the statistics above is that there WERE NOT ANY DEATHS related to CPM. Now, I really believe that’s not possible at all. Obviously, there’s information that is missing. ūüė¶

Now this makes a little more sense. If you list the number of diagnosis of CPM that is diagnosed in combination with another disorder/disease, then the number of those who impacted jumps dramatically:

2010 National statistics – all-listed
You have chosen all-listed diagnoses. The only possible measure for all-listed diagnoses is the number of discharges who received the diagnoses you selected. If you want to see statistics on length of stay or charges, go back and select “principal diagnosis.”
341.8 Cns Demyelination Nec
341.8 Cns Demyelination Nec Standard errors
Total number of discharges 2,490 190

The following chart is the number of those who have been diagnosed with CPM over the past 18 years. Considering that the number of cases of hyponatremia have increased over the past 10 years, it is a bit unusual not to see the same type of increase in the number of cases of CPM. Again, I have to wonder if the data reported on CPM, due to the nature that it is usually caused by malpractice, is in accurate. I will continue to try to find out information as it becomes available.

HCUPnet provides trend information for the 18 year period: 1993-2010

Number of discharges
ICD-9-CM all-listed diagnosis code and name 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
341.8 Cns Demyelination Nec 1,956 1,831 2,127 2,386 2,594 2,300 1,906 1,711 1,662 1,666 2,003 2,097 2,103 2,435 2,537 2,299 2,168 2,490

Keep in mind, that the above information is the number of people DISCHARGED. This is not a record of the number of deaths related to CPM.

Please use the following website to find out more information regarding CPM. You have to do research on all hospitals in the nation and use the ICD code 341.8 to locate these charts.

Also, please feel free to contact me with any questions.

 

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Hyponatremia: Statistics Updated:

Well, folks, I hate to say that I was right, but I was right. The number of hospitalizations due to hyponatremia increased in 2010. It is an ongoing epidemic, and one that needs to be addressed.

I’m am praying that if you read this post, you will do your part in spreading the word about hyponatremia. PLEASE, share my blog with your friends, family, neighbors, co-workers, ANYONE and EVERYONE that you know. It’s preventable, and it should be a household name.

The following information was obtained from, HCUPnet: http://hcupnet.ahrq.gov/HCUPnet.jsp

2010 National statistics – all-listed
You have chosen all-listed diagnoses. The only possible measure for all-listed diagnoses is the number of discharges who received the diagnoses you selected. If you want to see statistics on length of stay or charges, go back and select “principal diagnosis.”
276.1 Hyposmolality
276.1 Hyposmolality Standard errors
Total number of discharges 1,901,923 48,831

Weighted national estimates from HCUP Nationwide Inpatient Sample (NIS), 2010, Agency for Healthcare Research and Quality (AHRQ), based on data collected by individual States and provided to AHRQ by the States. Total number of weighted discharges in the U.S. based on HCUP NIS = 39,008,298. Statistics based on estimates with a relative standard error (standard error / weighted estimate) greater than 0.30 or with standard error = 0 in the nationwide statistics (NIS, NEDS, and KID) are not reliable. These statistics are suppressed and are designated with an asterisk (*). The estimates of standard errors in HCUPnet were calculated using SUDAAN software. These estimates may differ slightly if other software packages are used to calculate variances.

This is a table of the people above that are impacted by age:

Patient and hospital characteristics for
ICD-9-CM all-listed diagnosis code
276.1 Hyposmolality

Total number of discharges Standard errors
Total number of discharges
All discharges 1,901,923 (100.00%) 48,831
Age group <1 25,749 (1.35%) 2,251
1-17 25,657 (1.35%) 2,808
18-44 199,628 (10.50%) 7,021
45-64 586,155 (30.82%) 16,448
65-84 777,902 (40.90%) 21,587
85+ 286,523 (15.06%) 8,866
Missing * *

SO, the majority of those who are being treated for hyponatremia are the elderly. This information tends to be true for the majority of illness and disease. The elderly and children tend to be the targets for most health concerns. However, surprisingly, after the elderly between the ages of 65 and older, the next largest group are adults age 45 to 64. So, children are less likely to develop this than other age groups. I thought that was pretty interesting.

The following section of information includes additional statistics, which I found also surprising. Usually, illnesses or disease tends to target those impoverished, but that is not the case for hyponatremia. Women develop it more than men. Please take your time to read the following statistics, and feel free to ask me questions if you need assistance deciphering the figures.

Patient and hospital characteristics for
ICD-9-CM all-listed diagnosis code
276.1 Hyposmolality
Total number of discharges Standard errors
Total number of discharges
All discharges 1,901,923 (100.00%) 48,831
Sex Male 863,661 (45.41%) 22,666
Female 1,038,073 (54.58%) 26,924
Missing * *
Median income for zipcode Low 525,033 (27.61%) 21,741
Not low 1,330,533 (69.96%) 42,237
Missing 46,357 (2.44%) 4,125
Patient residence Large central metro 511,650 (26.90%) 38,083
Large fringe metro (suburbs) 460,735 (24.22%) 35,726
Medium and small metro 534,770 (28.12%) 39,687
Micropolitan and noncore (rural) 357,490 (18.80%) 18,234
Missing 37,278 (1.96%) 9,566

Weighted national estimates from HCUP Nationwide Inpatient Sample (NIS), 2010, Agency for Healthcare Research and Quality (AHRQ), based on data collected by individual States and provided to AHRQ by the States. Total number of weighted discharges in the U.S. based on HCUP NIS = 39,008,298. Statistics based on estimates with a relative standard error (standard error / weighted estimate) greater than 0.30 or with standard error = 0 in the nationwide statistics (NIS, NEDS, and KID) are not reliable. These statistics are suppressed and are designated with an asterisk (*). The estimates of standard errors in HCUPnet were calculated using SUDAAN software. These estimates may differ slightly if other software packages are used to calculate variances.

If you want to test whether apparent differences are significant, use the Z-Test Calculator. A p-value of less than 0.05 is generally considered statistically significant.

Here is the statistics for those who developed hyponatremia in 2009:

2009 National statistics – all-listed
You have chosen all-listed diagnoses. The only possible measure for all-listed diagnoses is the number of discharges who received the diagnoses you selected. If you want to see statistics on length of stay or charges, go back and select “principal diagnosis.”
276.1 Hyposmolality
276.1 Hyposmolality Standard errors
Total number of discharges 1,735,847 52,458

Weighted national estimates from HCUP Nationwide Inpatient Sample (NIS), 2009, Agency for Healthcare Research and Quality (AHRQ), based on data collected by individual States and provided to AHRQ by the States. Total number of weighted discharges in the U.S. based on HCUP NIS = 39,434,956. Statistics based on estimates with a relative standard error (standard error / weighted estimate) greater than 0.30 or with standard error = 0 in the nationwide statistics (NIS, NEDS, and KID) are not reliable. These statistics are suppressed and are designated with an asterisk (*). The estimates of standard errors in HCUPnet were calculated using SUDAAN software. These estimates may differ slightly if other software packages are used to calculate variances.

NOW, I HAVE TO SAY THIS: I NOTICED THAT THERE WAS A DISCREPANCY, A SIGNIFICANT DISCREPANCY, IN THOSE LISTED AS TO HAVE HYPONATREMIA IN 2009, AS THE ONLY DIAGNOSIS IN 2009 VS THE DATA LISTED IN 2010. WHEN I SELECTED HYPOSMOLALITY AS THE ONLY DIAGNOSIS CODE IN 2009, THE STATISTICS DROPPED TO ~90,000 PEOPLE. HOWEVER, WHEN I SELECTED HYPOSMOLALITY AS BEING A DIAGNOSIS WITH OTHER MEDICAL CONDITIONS, THERE WERE OVER 1.7 MILLION. WHEN I FUNNELED THE SAME SEARCH OPTIONS INTO THE 2010 DATA, THE NUMBER WAS THE SAME FOR BOTH SEARCHES.

WHAT DOES THIS MEAN?

I think the information was coded incorrectly in previous years, or in 2010, but it’s difficult to say which information is correct. It is accurate to say that there are millions being treated for hyponatremia each year, but it is apparently difficult to determine if they are developing hyponatremia while being treated in the hospital for other conditions or whether or not they are being hospitalized because they have hyponatremia on its own.

I hope that makes sense, but it’s important to keep that in mind when reviewing the statistics.

I hope to obtain the same information for CPM/EPM, but it’s more difficult because it is rare, and I don’t believe there is an actual single diagnosis code for it. In other words, they include CPM/EPM, in a blanket diagnosis code for central nervous system injury, which can include numerous other injuries.

Well, there you go folks. I am completely exhausted, so I am going to leave it there right now. Please, if you read my blog, and feel that I dropped the ball on a topic or think there should be expansion on a topic, PLEASE, PLEASE, let me know. I do not remember the things I’ve posted about before, and it’s difficult for me to go back and read through my other posts, so I am relying on you to keep me on track.

Thank you!

 

Hyponatremia: YOU’LL WANT TO READ THIS. Statistics.

I have been trying¬†to locate¬†statistics for hyponatremia for months. I have searched hundreds of websites. I have tried contacting local hospitals. FINALLY, I’ve had a breakthrough, and it’s a HUGE breakthrough.

There is a research tool funded by the government and due to the Freedom of Information Act hospitals must post their annual diagnostic statistics.

I’m a novice at researching facts on this website, so as I am able to locate more information, I will be certain to post it. Without further adieu, here is the golden nugget for hyponatremia.

First, let me explain that hyponatremia is coded as hyponatremia/and or Hyposmolality. The ICD-9-CM code for this is 276.1. This is the medical billing code used by doctors and hospitals to receive payment from insurance companies or medicaid/medicare. Please use the following link to confirm the diagnositc codes:

http://www.icd9data.com/2011/Volume1/240-279/270-279/276/default.htm

To make this a little more accesible, I will simply copy and paste the essential information from the above site:

2011 ICD-9-CM Diagnosis Code 276.1convert to ICD-10-CM

Hyposmolality and/or hyponatremia
  • abnormally low sodium levels in the blood; salt depletion.
  • Abnormally low blood sodium level.
  • Hypernatremia; lower than normal levels of sodium in the circulating blood.

Let me point out that the above information, contains an error. Hypernatremia is not LOWER than normal sodium levels. I believe this is simply an editing error and that the above description should read: Hyponatremia; lower than normal levels of sodium in the circulating blood. I believe this is a logical deduction considering the title of the code is a description of hyposmolality and/or hyponatremia, not hypernatremia.  I would also like to reassure you that hyposmolality is another way to describe hyponatremia.

There are further codes that describe other electrolytic disorders, like hyperkalemia (high potassium), etc.

That said, check out the following information from this link:

http://hcupnet.ahrq.gov/HCUPnet.jsp

This link has the motherload for statistics for hyponatremia, and it is astounding!

The following is taken directly from the above link:

HCUPnet provides trend information for the 17 year period: 1993-2009

Number of discharges
ICD-9-CM all-listed diagnosis code and name 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
276.1 Hyposmolality 1,035,284 1,114,170 1,100,355 1,011,519 975,253 922,323 773,223 753,530 905,743 923,473 1,005,420 1,105,431 1,239,144 1,265,353 1,362,216 1,602,836 1,735,847

YES, you are reading that right. In most years, more than a MILLION people per year are diagnosed with hyponatremia. WOW! I would also like to point out that the incidence of hyponatremia has been STEADILY increasing since 1999! I think this speaks volumes for why hyponatremia/CPM and EPM should be a household name.

The following are the maximum amount of error that’s possible each year with this diagnosis. What does that mean?

It means that the statistics, for example, in 2009 has a possible range in error of being a maximum of  1,788,305 and a minimum of
1,683,389. Each year, there is a maximum number of errors that can positively or negatively impact the reported data. The following table documents the number of possible errors.  Please feel free to post any questions associated with this.

Number of discharges – Standard Errors
ICD-9-CM all-listed diagnosis code and name 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
276.1 Hyposmolality 35,104 36,817 37,056 36,746 36,207 35,803 20,986 19,120 21,021 22,157 23,650 27,058 34,350 34,636 31,387 44,683 52,458

The next description is the how they determined the above chart regarding possible errors.

Weighted national estimates from HCUP Nationwide Inpatient Sample (NIS), Agency for Healthcare Research and Quality (AHRQ), based on data collected by individual States and provided to AHRQ by the States. Statistics based on estimates with a relative standard error (standard error / weighted estimate) greater than 0.30 or with standard error = 0 in the nationwide statistics (NIS, NEDS, and KID) are not reliable. These statistics are suppressed and are designated with an asterisk (*). The estimates of standard errors in HCUPnet were calculated using SUDAAN software. These estimates may differ slightly if other software packages are used to calculate variances.

Bottom Line:

There are an extremely large number of people being hospitalized each year for hyponatremia. This number is on the rise, and it is of the utmost importance to spread the facts about hyponatremia, the proper treatment and what occurs if it is not treated properly (CPM/EPM).

Please continue to read this blog. Forward the information to friends and family. Post links to your FaceBook pages, Twitter, etc. Please, help spread the word and save people’s lives.

 

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