Query purpose:
This definition is intended to capture visits related to acute flaccid myelitis (AFM). The definition should capture visits with an AFM-related discharge diagnosis code or free-text mention.
How it works:
The Discharge Diagnosis Parsed Free Text field and Chief Complaint History field are used to query discharge diagnosis codes and free text, respectively, with exclusions separately applied to Chief Complaint History, Triage Notes Orig, and CCDD Parsed, to develop the syndrome definition.
- Inclusions based on AFM-related discharge diagnosis codes (applied to Discharge Diagnosis Parsed Free Text also apply to Chief Complaint History):
- A discharge diagnosis code of Acute Flaccid Myelitis (G04.82), Other specified viral infections of central nervous system (A88.8), Postimmunization acute disseminated encephalitis, myelitis and encephalomyelitis (G04.82), Other myelitis (G04.89), Encephalitis, myelitis, and encephalomyelitis, unspecified (G04.9), Flaccid hemiplegia (G81.0), Paraplegia, unspecified (G82.20), Paraplegia, complete (G82.21), Paraplegia, incomplete (G82.22), Paralytic syndrome, unspecified (G83.9), Weakness and viral infection, unspecified (R53.1 and B34.9)
- Exclusions based on discharge diagnosis codes (applied to CCDD Parsed):
- Guillain-Barre syndrome (G61.0), Accident/assault/injury related (V/W/X ICD-10 codes), Personal history of other (healed) physical injury and trauma (Z87.828), Brain stem stroke syndrome (G46.3), Cerebellar stroke syndrome (G46.4), National Institutes of Health Stroke Scale (NIHSS) score (R29.7), Cerebral infarction, unspecified (I63.9), Other sequelae of cerebral infarction (I69.39), Multiple sclerosis (G35), Neuromyelitis optica (G36.0), Epilepsy and recurrent seizures (G40), Exposure to other specified electric current (W86), Electrocution (T754)
- Inclusions based on AFM-related free text terms (applied to Discharge Diagnosis Parsed Free Text also apply to Chief Complaint History):
- “AFM”, “ACUTE FLACCID”, “ACUTE FLACID”, “ACUTE POLIO”, “PARALYTIC”, “ENCEPHALITIS”, “MYELITIS” AND NOT “OSTEOMYELITIS” OR “OSTEMYELITIS”, “FLACCID HEMI”, “WEAK” OR “SENSATION” AND “LIMB” OR “LEG” OR “ARM” OR “HAND”
- Exclusions based on free text terms (applied to Chief Complaint History and Triage Notes Orig):
- “ACCIDENT”, “TRAUMA”, “INJUR”, “WOUND”, “STROKE”, “SEIZ”, “MIGRAINE”, “NUMB”, “SEPSIS”, “ULCER”, “CELLULITIS”, “SCIATIC”, “DISC”, “NECROTIC”, “URINARY TRACT”, “UTI”, “PHYSICAL THER”, “NEOPLASM”, “TUMOR”, “CLOT”, “EMBOLISM”, “CATHETER”, “CATH CHANGE”, “CATH PROBLEM”
Plain language description:
This definition will return visits with an AFM-related ICD-10 discharge diagnosis code (G04.82, A88.9, G04,98, etc.) or free-text chief-complaint (AFM, Acute Flaccid, weak and leg, etc.). It will exclude visits with an ICD-10 discharge diagnosis code related to non-AFM conditions including injury, stroke, etc. (I63.9, T754, G61.0, etc.) or a free-text term in the chief-complaint history or triage notes indicative of a non-AFM-related reason for visit (trauma, stroke, migraine, UTI, etc.).
For consideration:
Visits presenting with limb weakness due to injuries or existing conditions and visits presenting with generalized weakness still occur, but the volume is much lower than in previous AFM definitions. These visits are unavoidable given our inclusion of “weak” and “limb” or “arm” or “leg” or “hand” and must be manually ruled out. The free-text “extremity weak” was intentionally not added as an inclusion-criteria as it largely increased the number of false positives due to generalized extremity weakness. “Generalized weakness” and “encephalitis” may be explored as exclusion-criteria in future definition iterations. For the manual review, interpretation of “viral symptoms” was left to the reviewer but generally included respiratory or gastrointestinal symptoms. This definition is primarily intended for case finding and has a low PPV. It is not recommended to be used for time series for public display. This definition will exclude visits with ICD-9 “V codes”. Further, visits with the AFM ICD-10 code may be excluded by free-text negation terms. It is recommended to compare results to CCDD category CDC Acute Flaccid Myelitis DD v1.
Discharge Diagnosis Parsed Free Text and also apply to Chief Complaint History
^[;/ ]G0482^,or,(,^[;/ ]A888^,or,^[;/ ]G0402^,or,^[;/ ]G0489^,or,^[;/ ]G049^,or,^[;/ ]G810^,or,^[;/ ]G8220^,or,^[;/ ]G8221^,or,^[;/ ]G8222^,or,^[;/ ]G839^,or,(,^[;/ ]R531^,AND,^[;/ ]B349^,),or,!AFM!,or,^[;/ ]AFM[;/ ]^,or,^ACUTE FLACCID^,OR,^ACUTE FLACID^,OR,^ACUTE POLIO^,OR,^PARALYTIC^,OR,^ENCEPHALITIS^,OR,^MYELITIS^,ANDNOT,(,^OSTEOMYELITIS^,OR,^OSTEMYELITIS^,),OR,^FLACCID HEMI^,OR,(,^LIMB^,OR,^LEG^,OR,!ARM!,OR,^[;/ ]ARM[;/ ]^,OR,^HAND^,),AND,(,(,^WEAK^,ANDNOT,^NO WEAK^,),OR, (,^SENSATION^,ANDNOT,(,^BURNING^,OR,^ITCH^,),),),),ANDNOT,(,^[;/ ]G610^,OR,^[;/ ][VWX][0-9][0-9]^,OR,^[;/ ]Y[023678]^,OR,^[;/ ]Z87828^,OR,^ACCIDENT^,OR,^TRAUMA^,ANDNOT,(,^NO TRAUMA^,OR,^DENIES TRAUMA^,OR,^DENIES ANY TRAUMA^,OR,^NO KNOWN TRAUMA^,),OR,^INJUR^,ANDNOT,(,^NO INJUR^,OR,^DENIES INJUR^,OR,^NO KNOWN INJUR^,OR,^DENIES AN INJUR^,OR,^DENIES ANY INJUR^,),OR,^WOUND^,OR,^STROKE^,OR,^SEIZ^,OR,^MIGRAINE^,OR,^NUMB^,OR,^STROKE^,OR,^SEPSIS^,OR,^ULCER^,OR,^CELLULITIS^,OR,^SCIATIC^,OR,^DISC[;/ ]^,OR,^NECROTIC^,OR,^URINARY TRACT^,OR,!UTI!,OR,^[;/ ]UTI[;/ ]^,OR,^PHYSICAL THER^,OR,^NEOPLASM^,OR,^TUMOR^,OR,^CLOT[ST;/ ]^,OR,^EMBOLISM^,OR,^CATHETER^,OR,^CATH CHANGE^,OR,^CATH PROBLEM^,OR,^[;/ ]G46[34]^,OR,^[;/ ]R297^,OR,^[;/ ]I639^,OR,^[;/ ]I6939^,OR,^STROKE^,OR,^[;/ ]G35^,OR,^[;/ ]G360^,OR,^[;/ ]G40^,OR,^[;/ ]W86^,OR,^[;/ ]T754^,)
Chief Complaint History
ISNULL,OR,^,ANDNOT,(,^ACCIDENT^,OR,^TRAUMA^,ANDNOT,(,^NO TRAUMA^,OR,^DENIES TRAUMA^,OR,^DENIES ANY TRAUMA^,OR,^NO KNOWN TRAUMA^,),OR,^INJUR^,ANDNOT,(,^NO INJUR^,OR,^DENIES INJUR^,OR,^NO KNOWN INJUR^,OR,^DENIES AN INJUR^,OR,^DENIES ANY INJUR^,),OR,^WOUND^,OR,^STROKE^,OR,^SEIZ^,OR,^MIGRAINE^,OR,^NUMB^,OR,^STROKE^,OR,^SEPSIS^,OR,^ULCER^,OR,^CELLULITIS^,OR,^SCIATIC^,OR,^DISC[;/ ]^,OR,^NECROTIC^,OR,^URINARY TRACT^,OR,!UTI!,OR,^[;/ ]UTI[;/ ]^,OR,^PHYSICAL THER^,OR,^NEOPLASM^,OR,^TUMOR^,OR,^CLOT[ST;/ ]^,OR,^EMBOLISM^,OR,^CATHETER^,OR,^CATH CHANGE^,OR,^CATH PROBLEM^,)
Triage Notes Orig
ISNULL,OR,^,ANDNOT,(,^ACCIDENT^,OR,^TRAUMA^,ANDNOT,(,^NO TRAUMA^,OR,^DENIES TRAUMA^,OR,^DENIES ANY TRAUMA^,OR,^NO KNOWN TRAUMA^,),OR,^INJUR^,ANDNOT,(,^NO INJUR^,OR,^DENIES INJUR^,OR,^NO KNOWN INJUR^,OR,^DENIES AN INJUR^,OR,^DENIES ANY INJUR^,),OR,^WOUND^,OR,^STROKE^,OR,^SEIZ^,OR,^MIGRAINE^,OR,^NUMB^,OR,^STROKE^,OR,^SEPSIS^,OR,^ULCER^,OR,^CELLULITIS^,OR,^SCIATIC^,OR,^DISC[;/ ]^,OR,^NECROTIC^,OR,^URINARY TRACT^,OR,!UTI!,OR,^[;/ ]UTI[;/ ]^,OR,^PHYSICAL THER^,OR,^NEOPLASM^,OR,^TUMOR^,OR,^CLOT[ST;/ ]^,OR,^EMBOLISM^,OR,^CATHETER^,OR,^CATH CHANGE^,OR,^CATH PROBLEM^,)
CC and DD Parsed Free Text
^[;/ ]G0482^,OR,ISNULL,OR,^,ANDNOT,(,^[;/ ]G610^,OR,^[;/ ][VWX][0-9][0-9]^,OR,^[;/ ]Y[023678]^,OR,^[;/ ]Z87828^,OR,^[;/ ]G46[34]^,OR,^[;/ ]R297^,OR,^[;/ ]I639^,OR,^[;/ ]I6939^,OR,^[;/ ]G35^,OR,^[;/ ]G360^,OR,^[;/ ]G40^,OR,^[;/ ]W86^,OR,^[;/ ]T754^,)