ICD-10-CM–Based Definitions for Emergency Department Opioid Poisoning Surveillance: Electronic Health Record Case Confirmation Study

Svetla Slavova, Dana Quesinberry, Julia F. Costich, Emilia Pasalic, Pedro Martinez, Julia Martin, Sarah Eustice, Peter Akpunonu, Terry L. Bunn

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objectives: Valid opioid poisoning morbidity definitions are essential to the accuracy of national surveillance. The goal of our study was to estimate the positive predictive value (PPV) of case definitions identifying emergency department (ED) visits for heroin or other opioid poisonings, using billing records with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Methods: We examined billing records for ED visits from 4 health care networks (12 EDs) from October 2015 through December 2016. We conducted medical record reviews of representative samples to estimate the PPVs and 95% confidence intervals (CIs) of (1) first-listed heroin poisoning diagnoses (n = 398), (2) secondary heroin poisoning diagnoses (n = 102), (3) first-listed other opioid poisoning diagnoses (n = 452), and (4) secondary other opioid poisoning diagnoses (n = 103). Results: First-listed heroin poisoning diagnoses had an estimated PPV of 93.2% (95% CI, 90.0%-96.3%), higher than secondary heroin poisoning diagnoses (76.5%; 95% CI, 68.1%-84.8%). Among other opioid poisoning diagnoses, the estimated PPV was 79.4% (95% CI, 75.7%-83.1%) for first-listed diagnoses and 67.0% (95% CI, 57.8%-76.2%) for secondary diagnoses. Naloxone was administered in 867 of 1055 (82.2%) cases; 254 patients received multiple doses. One-third of all patients had a previous drug poisoning. Drug testing was ordered in only 354 cases. Conclusions: The study findings suggest that heroin or other opioid poisoning surveillance definitions that include multiple diagnoses (first-listed and secondary) would identify a high percentage of true-positive cases.

Original languageEnglish
Pages (from-to)262-269
Number of pages8
JournalPublic Health Reports
Issue number2
StatePublished - Mar 1 2020

Bibliographical note

Publisher Copyright:
© 2020, Association of Schools and Programs of Public Health.


  • case definition
  • heroin poisoning
  • opioid poisoning
  • positive predictive value

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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