help for altcharl -------------------------------------------------------------------------------

Title

altcharl -- Charlson Score & Comorbidities

Version

Version 3.0.

ICDPIC Version 3.0 requires STATA 8.0 or higher. ICDPIC Version 3.0 has been tested in STATA 10 and STATA 11, but the authors believe it should also work without incident in STATA 8 and STATA 9. If you have any problems using ICDPIC Version 3.0 in STATA 8 or STATA 9, please inform the authors.

ICDPIC Version 3.0 may be installed from within STATA using the ssc command. If you installed a previous version of ICDPIC from the SSC archives website using the ssc command, we suggest that you first delete it by typing ssc uninstall icdpic followed by ssc install icdpic. Alternatively, you may use ssc install icdpic, replace. See help for ssc.

If you installed any previous ICDPIC files obtained directly from the authors, please delete them ALL (.ado, .hlp and .dta files) to avoid any conflicts with ICDPIC 3.0 files.

Please enter complete variable names in the ICDPIC Version 3.0 dialog boxes. Do not use abbreviations.

New to Version 3.0 is the addition of a dialog box (.dlg) file associated with each individual ICDPIC Version 3.0 program (.ado) file. To access the ICDPIC dialog box, and all the ICDPIC programs, type: db icdpic. Typing icdpic, as in earlier versions, will still work, but ONLY with icdpic. For example, to access the Charlson Score\Comorbidities (Alternate Version) program directly, type: db altcharl. Typing altcharl, as in previous versions, will produce an error.

Fixed in ICDPIC Version 3.0 is the ability to use path\file names containing spaces.

Fixed in ICDPIC Version 3.0 is the ability to run in STATA 11.0.

Fixed in ICDPIC Version 3.0 is a bug that caused the triss program to crash if the rts variable was named anything other than "rts".

New in ICDPIC Version 3.0 (trauma program only) is the ability to choose whether an AIS value of 6 automatically forces an ISS of 75 or to automatically have all AIS values of 6 changed to an AIS value of 5 and then have the ISS calculated normally.

All dialog boxes in ICDPIC Version 3.0 have memory. Each time a dialog box is opened within the same STATA session, it will remember the values last entered.

All dialog boxes in ICDPIC Version 3.0 have the following buttons:

OK executes the program and removes the dialog box from the screen.

SUBMIT executes the program and leaves the dialog box on the screen. Note that if an error message is generated the dialog box may be minimized.

CANCEL removes the dialog box from the screen and does nothing. Clicking on the close icon of the dialog box does the same thing.

HELP leaves the dialog box on the screen and presents the program help file. The HELP button has a question mark on it.

COPY leaves the dialog box on the screen and copies the program command to the clipboard.

RESET resets the values of the controls in the dialog box to their initial state, just as if the dialog box were invoked for the first time. Each time a user invokes a dialog box, its controls will be filled in with the values the user last entered. RESET restores the control values to their defaults. The RESET button has an R on it.

Syntax

db altcharl

The Charlson Score & Comorbidities (Alt. Ver.) dialog box will open. Follow the instructions.

OR

db icdpic

The ICDPIC dialog box will open. Choose Charlson Score\Comorbidities (Alternate Version) and click OK or Submit. The Charlson Score & Comorbidities (Alt. Ver.) dialog box will open. Follow the instructions.

Description

altcharl determines which Charlson comorbidities are present, the number of Charlson comorbidities present and the Charlson score.

CHARLSON SCORE = the sum of the weights of each comorbidity present

If mild liver disease and moderate to severe liver disease are both present, only the presence of moderate to severe liver disease is used in calculating the Charlson score. If both mild to moderate diabetes mellitus and diabetes mellitus, chronic complications, are both present, only the presence of diabetes mellitus, chronic complications, is used in calculating the Charlson score. If any malignancy and metastatic solid tumor are both present, only the presence of metastatic solid tumor is used in calculating the Charlson score. The above also pertains in determining which comorbidities are present and calculating the number of comorbidities. For example, if both mild and moderate to severe liver disease are present only the moderate to severe liver disease variable indicates the presence of a comorbidity and is counted in determining both the number of comorbidities and the Charlson score.

Comorbidity diagnostic categories are included if, and only if, they include ICD-9-CM codes identified by Romano et al, with an asterisk under the column "Dartmouth-Manitoba codes" in Table 1 of that study. Within these included categories, only diagnosis or procedure codes with asterisks are used. Exceptions are Rheumatologic Disease and AIDS categories, which were too rare to be included in the original study but have been included in our version.

A complete list of all categories, diagnosis codes and procedure codes used to calculate our version of the Charlson Score is given below.

> Comorbidity ICD-9-CM Diagnosis Code* ICD-9-CM Pr > ocedure Code*

Myocardial Infarction 412

Peripheral Vascular 440.X, 441.X, 442.X, 39.22-39.26 > , 39.29, Disease 443.1-443.9, 447.1, 38.13, 38.1 > 4, 38.16, 785.4 38.18, 38.3 > 3, 38.34, 38.36, 38.3 > 8, 38.43, 38.44, 38.4 > 6, 38.48 Dementia 290-290.9, 331-331.2

Chronic Obstructive 415.0, 416.8-416.9, Pulmonary Disease 491.X-494, 496 Rheumatologic Disease 710.X, 714.X

Mild Liver Disease 571.2, 571.5-571.6, 571.8-571.9

Moderate to Severe 572.2-572.4, 39.1, 42.9 > 1 Liver Disease 456.0-456.2X

Mild to Moderate 250.0X-250.3X Diabetes Mellitus

Diabetes Mellitus, 250.4X-250.9X Chronic Complications

Renal Disease 585-586, V42.0, V45.1, 39.27, 39. > 42, V56.X, V56.8 39.93-39.9 > 5, 54.98

Any Malignancy 140.X-171.X, 60.5, 62.4 > -62.41** 174.X-195.X, 200.X-208.X, 273.0, 273.3, V10.46

Metastatic Solid Tumor 196.X-199.X

AIDS 042-044.9**

*NOTE1: Diagnosis and procedure code reference tables have been updated to reflect new codes within the above specified ranges. No attempt has been made to identify and include individual codes that may be applicable.

**NOTE2: Diagnosis codes 43.X and 44.X are no longer valid and are not included in the diagnosis code reference table. Procedure code 62.4 seems to have always been a sub category rather than an actual procedure code but has been left in as it will not cause any harm.

CATEGORIES EXCLUDED:

Congestive Heart Failure Cerebrovascular Disease Peptic Ulcer Disease Hemiplegia or Paraplegia

VARIABLES ADDED TO THE USER'S DATA:

Boolean variables for each comorbidity category: 0 if absent; 1 if pres > ent A variable to count the number of comorbidities present A variable for the Charlson score

WEIGHTED COMORBIDITIES AS SUGGESTED BY CHARLSON:

Myocardial Infarction = 1 Peripheral Vascular Disease = 1 Dementia = 1 Chronic Obstructive Pulmonary Disease = 1 Rheumatologic Disease = 1 Mild Liver Disease = 1 Mild to Moderate Diabetes Mellitus = 1 Renal Disease = 2 Diabetes Mellitus, Chronic Complications = 2 Any Malignancy = 2 Moderate to Severe Liver Disease = 3 Metastatic Solid Tumor = 6 AIDS = 6

For a more standardized treatment of the Charlson comorbidity index, with options that include ICD-9-CM, ICD-10-CM and enhanced ICD-9-CM versions, the user is encouraged to type "findit charlson" from within STATA without the quotation marks. STATA will locate this module on the Internet. Just follow the instructions given to download it.

See also the Options and Remarks sections for IMPORTANT information on, and requirements for, altcharl.

Options

ICD-9-CM diagnosis and procdure codes in the user's data may, or may not, contain a decimal point. Simply choose the option that applies to your data in the Charlson Score & Comorbidities (Alt. Ver.) dialog box.

Remarks

altcharl adds the following Boolean variables (0 if absent, 1 if present) to a new copy of the user's data stored on disk:

mi: myocardial infarction pvd: peripheral vascular disease dementia: dementia copd: chronic obstructive pulmonary disease rheum: rheumotologic disease mld: mild liver disease sld: moderate to severe liver disease mdm: moderate diabetes mellitus ccdm: chronic complications of diabetes mellitus renal: renal disease any_mal: any malignancy mst: metastatic solid tumor aids: AIDS

altcharl also adds the following variables to a new copy of the user's data stored on disk:

charlcnt: the total number of comorbidities present charlval: the Charlson score

The user's data must contain both ICD-9-CM diagnosis codes and ICD-9-CM procedure codes. ICD-9-CM codes in the user's data must be of type string. A decimal point in the ICD-9-CM codes is optional. Diagnosis codes should have a width of 5 (6 if a decimal point is present) and procedure codes should have a with of 4 (5 if a decimal point is present). The diagnosis code prefix must be the same for all diagnosis codes and numbered sequentially starting with 1, for example, dx1...dxN. The same holds true for procedure codes, for example, px1...pxN.

altcharl requires the use of lookup tables cdtab_s1.dta, cdtab_s2.dta, cptab_s1.dta and cptab_2.dta. These data tables are supplied. _s1 tables are for use with data without the decimal point in ICD-9-CM codes and _s2 tables are for data that include the decimal point. See help for icdpic, specifically the LOOKUP TABLES part of the Remarks section.

Examples

None

Authors

David E. Clark, M.D.

Maine Medical Center, Portland, Maine, USA University of Vermont College of Medicine, Burlington, Vermont, USA Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts, USA

Correspondence to Dr. Clark, 887 Congress Street, Portland ME 04102 Email: clarkd@mmc.org

Turner M. Osler, M.D.

University of Vermont College of Medicine, Burlington, Vermont, USA

David R. Hahn

Maine Medical Center, Portland, Maine, USA

References

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40:373-383.

Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: Differing perspectives. J Clin Epidemiol 1993;46:1075-1079.

Also see

help for icdpic

help for altcharl