Increasing diagnoses per patient admission at a specialist children’s hospital: a retrospective study
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Objective
In adult practice there is recognition that average patient complexity is increasing, with a greater proportion of patients having multiple diagnoses or comorbidities. This study aims to examine whether there has been a change in number of recorded coexisting diagnoses per patient over a 24-year period for children attending as in-patients to a specialist children’s hospital in England.
Methods
Following all in-patient admissions, patient episodes are allocated specific diagnosis codes (ICD-10) by a specialist clinical coding team according to standard NHS criteria and guidance. We examine the number of coexisting diagnoses allocated per patient admission over a 24-year period.
Results
From a total of 278,579 overnight in-patient admissions during the study period (2000–2023) there were 1,023,276 ICD-10 patient diagnoses. The mean number of diagnoses per admission increased from 2.72 to 10.43 over the period (Kendall’s tau statistic of 0.93; p-value < 0.001), an increase of 284% (95% confidence interval 275% - 293%).
Conclusions
Over recent decades, the recorded complexity of patients attending a specialist children’s hospital appear to have increased significantly, with an almost 3-fold increase in the number of coexisting diagnoses present per admission. The cause of this finding cannot be determined from the data; however, it appears to be gradual and consistent, and across all speciality areas suggesting biological or referral factors rather than artefactual coding issues. Recognition of such a trend is important when interpreting retrospective data for AI, research, and planning purposes.
In adult practice there is recognition that average patient complexity is increasing, with a greater proportion of patients having multiple diagnoses or comorbidities. This study aims to examine whether there has been a change in number of recorded coexisting diagnoses per patient over a 24-year period for children attending as in-patients to a specialist children’s hospital in England.
Methods
Following all in-patient admissions, patient episodes are allocated specific diagnosis codes (ICD-10) by a specialist clinical coding team according to standard NHS criteria and guidance. We examine the number of coexisting diagnoses allocated per patient admission over a 24-year period.
Results
From a total of 278,579 overnight in-patient admissions during the study period (2000–2023) there were 1,023,276 ICD-10 patient diagnoses. The mean number of diagnoses per admission increased from 2.72 to 10.43 over the period (Kendall’s tau statistic of 0.93; p-value < 0.001), an increase of 284% (95% confidence interval 275% - 293%).
Conclusions
Over recent decades, the recorded complexity of patients attending a specialist children’s hospital appear to have increased significantly, with an almost 3-fold increase in the number of coexisting diagnoses present per admission. The cause of this finding cannot be determined from the data; however, it appears to be gradual and consistent, and across all speciality areas suggesting biological or referral factors rather than artefactual coding issues. Recognition of such a trend is important when interpreting retrospective data for AI, research, and planning purposes.
Editor(s)
Ramagopalan, Sreeram V
Date Issued
2025-05-06
Date Acceptance
2025-03-31
Citation
PLoS One, 2025, 20 (5)
ISSN
1932-6203
Publisher
Public Library of Science (PLoS)
Journal / Book Title
PLoS One
Volume
20
Issue
5
Copyright Statement
Copyright: © 2025 Bowyer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
License URL
Identifier
10.1371/journal.pone.0322997
Publication Status
Published
Article Number
e0322997
Date Publish Online
2025-05-06