Diagnoses Encoding

LBP is one of the leading contributors to disease burden worldwide [1]. In France, LBP is a frequent reason of general practice consultations. According to a study published in 2017 and based on 2014 data issued of the National Health Insurance Cross-Schemes Information System (Sniiram) [2], this pathology stands for 30% of thickness leave and 4 of 5 people will suffer of low back pain during their own life. Most often, LBP is a chronic pathology with acute episodes which most often require emergency care. In order to prevent chronicity, French health care insurance launched into a mainstream national prevention campaign during spring 2018. This campaign was also targeted for health professional to inform them of the best recommendations to provide to their patients. Then the French society of emergency medicine (SFMU) has been asked to relay this campaign to emergency departments (ED) where LBP is a frequent reason of attendance. Since 2004, the French syndromic surveillance system SurSaUD® [3] coordinated by the French Public Health Agency (Santé publique France) daily collects morbidity data from the emergency departments (ED) network Oscour®. Almost 92% of the French ED attendances were recorded by the system in 2017. The availability of this large ED dataset on the whole territory since several years gives the opportunity to describe LBP attendances before the potential fallout of the national prevention campaign.

Objective: The study describes the characteristics of attendances for low back pain (LBP) in the French emergency departments (ED) network Oscour®, in order to give an overview of this disease before launching a prevention campaign.

As part of the French syndromic surveillance system SurSaUDî, the French Public Health Agency (Sant© publique France) collects daily data from the emergency department (ED) network OSCOUR®. The system aims to timely identify, follow and assess the health impact of unusual or seasonal events on emergency medical activity. Individual ED data contain demographic (age, gender, residence zip code), administrative (dates of attendances and discharge, ED, etc.) and medical information (chief complaint, main and associated medical diagnoses, severity). Medical diagnoses are encoded using the ICD10 classification. Then syndromic groups are built based on these ICD10 codes for ensuring syndromic surveillance in routine. Even if ICD10 is recommended on the national guidelines for coding ED attendances, this thesaurus offers a too large variety of codes. Particularly, it includes lots of diseases that may never be observed or confirmed in ED. This variety let selection of the appropriate codes difficult for physicians in a reactive use and could discourage them to code diagnoses. In order to encourage appropriate and reactive coding practice, we decided in 2017 to produce a new diagnoses thesaurus with a limited list of ICD10 codes. Then a committee of medical and epidemiological experts was created by the Federation of regional emergency observatories (FedORU), to propose an operational thesaurus that includes relevant codes for both ED in a daily routine practice and syndromic surveillance.

Objective: The study aims to evaluate the potential impact of the revision of the thesaurus used by ED physicians to code medical diagnoses, on the syndromic indicators used daily to achieve the detection objective of the French syndromic surveillance system.