It has already been 14 years since the Quality Working Group (WG) of the Spanish Society of Pediatric Emergencies (SEUP) published a list of diagnostic codes based on the International Classification of Diseases ICD-9-CM and adapted to the idiosyncrasies of Paediatric Emergency Departments (PEDs).1,2 The list included 182 codes that were selected according to the following criteria: frequently used diagnosis, non-specific enough to require a definition, and characteristic of emergency care. This coding system has been incorporated into most Spanish PEDs, providing us with a common language and a better knowledge of the overall epidemiology in our departments. Furthermore, its implantation has helped improve multicentre research and assess epidemiological differences in PED visits across autonomous communities. On the other hand, the SEUP diagnostic coding is part of the quality standards of Spanish PEDs.3

The increase in the competencies and specialties of PEDs in recent years has been reflected in their approach to patient management and clinical practice, which has become more child- and family-centred. As a consequence, management tools for ongoing quality improvement have been introduced, including the unification of diagnostic criteria and diagnostic coding. In this regard, in 2009 the WG asked 8 hospitals that had implemented the new coding system to provide a list of the 20 most frequent diagnoses of the first trimester of the year (Fig. 1), which revealed inconsistencies in the coding of certain diagnoses, especially those involving upper respiratory tract pathology. In light of this and a few other problems detected in the application of some of the diagnostic codes of the original list, the Quality WG of the SEUP decided, two years ago, to undertake a revision of this with three key objectives in mind:

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  Addition of codes, which were not included in the 2000 listing, due to their frequent or emerging use in PEDs.

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  Revision of the codes included in the original list to assess the exclusion of any potentially outdated codes.

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  Update of the codes of the original list to match the most recent version of the ICD-9-CM.

Figure 1.

Most frequent diagnoses in several Spanish PEDs in 2009. AbdPain, abdominal pain; AGE, acute gastroenteritis; AOM, acute otitis media; APT, acute pharyngotonsillitis; FI, febrile illness; HC, Hospital Universitario Cruces; HCb, Hospital Cabueñes; HGM, Hospital Universitario Gregorio Marañón; HLP, Hospital Universitario La Paz; HSD, Hospital Universitario Son Espases; HT, Consorci Sanitari de Terrassa; NHJ, Hospital Universitario Niño Jesús; RTI, respiratory tract infection; SJD, Hospital Sant Joan de Déu; TBI, traumatic brain injury.

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Our working process was the following.

We evaluated the current uniformity in diagnostic practise in Spanish PEDs, asking the hospitals of the WG members for a list of the 20 most frequent diagnoses in one trimester of the year (January 1 to March 31, 2014). In order to build a picture of the variability in coding, we developed a benchmark using the coding averages of the participating hospitals.

We asked the hospitals of the WG members to propose diagnoses to be added or removed from the general list. Proposing a diagnosis required providing an ICD-9 code accompanied by descriptor and a definition, following the same procedure used in the elaboration of the 2000 list.

The codes proposed for addition to the list were analysed by experts in medical documentation, who also updated the codes of the original list to match the 2014 version of the ICD-9-CM (9th edition).4

Fig. 2 shows a graph with the most frequent diagnoses in the WG participating hospitals for 2014. It is apparent that while there are still some coding inconsistencies, uniformity seems to have increased after the introduction of the SEUP coding system in the participating PEDs.

Figure 2.

Most different diagnoses in several Spanish PEDs in 2014. AbdPain, abdominal pain; AGE, acute gastroenteritis; AOM, acute otitis media; APT, acute pharyngotonsillitis; FI, febrile illness; H12OCT, Hospital Universitario 12 Octubre; HB, Hospital de Basurto; HC, Hospital de Cruces; HD, Hospital Universitario Donostia; HSJD, Hospital Sant Joan de Déu; HUV, Hospital Universitario Río Hortega; RTI, respiratory tract infection.

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The decision was made to keep all the codes included in the original list. Table 1 lists the 35 codes newly added, and Table 2 the updates to 15 codes that were already in the list. We have also included a list of traumatology codes that may be helpful to PEDs that have incorporated this specialty into their competencies (Table 3).

The updated SEUP diagnostic list is partly a reflection of the changes that our PEDs have been experiencing in recent years. This endeavour is not finished, as the key to the usefulness of the SEUP coding system is its continuous updating through the feedback and contribution of all its users.

A study has recently validated the application of the ICD-10 coding system to diagnostic coding in PEDs.5 This evolution in the coding system will be implemented in Spain in upcoming years, and adjusting to this new standard will require a new revision of our coding system.

We hope that the work we have done will contribute to the spread of this common language, which has been key in the management of PEDs and contributed to quality improvement and subspecialty development in this setting.

The authors have no conflicts of interest to declare.