2126. Disorders of Childhood Development in Congenital Cytomegalovirus
Authors: Rochat Ryan H , Demmler-Harrison Gail J 
Published: December 2022

Background

The spectrum of disease in congenital cytomegalovirus (cCMV) is broad. The widespread adoption of Electronic Medical Records (EMRs) at large academic centers suggests that high-throughput informatics approaches would be a reasonable means to extract relevant information to describe long term outcomes in cCMV. Database queries were used to extract records directly from EMR which describe progression of developmental and sensory disorders in cCMV.

Methods

SlicerDicerTM, a reporting tool in our Epic® EMR, was used to identify patients seen in our cCMV Clinic at Texas Children’s Hospital in Houston, Texas, between years 2008 and 2020, with a diagnosis of congenital cytomegalovirus (CMV) infection. ICD-10 diagnoses and encounters were extracted from our EMR with a series of generalizable Structured Query Language (SQL) queries. Using SAS V9.4 (Cary, N.C.), we parsed this information into relational databases and categorized ICD-10 codes by semantic terms associated with sensory and developmental disabilities guided by SNOMED-CT®.

Results

Data acquisition took seconds to complete and included over 55,000 unique encounters (Figure 1), 11,000 provider encounters, and 48,000 billing diagnoses. Of 152 patients with an ICD-10 diagnosis of cCMV, 112 were born after 1/1/2008 (when records were reliably found in our EMR). 76/112 (68%) had symptomatic cCMV (ScCMV), 36/112 (32%) had asymptomatic cCMV (AcCMV). 60 (79%) of ScCMV had at least one disorder of development noted in EMR compared with 20 (56%) of AcCMV (ChiSq: p&lt; 0.05). The average age of first diagnosis of a disorder of development was 1.9 +/- 1.6 years (median 1.6 years) (Figure 2). Of the 48,000 billing diagnoses recorded for these children, only 3,751 (8%) pertained to disorders of development, of which “Mixed receptive-expressive language disorder: F80.2” (n=713, 19%) was most frequent (Table 1).

Unique Encounters Across our Healthcare System by Department

Stacked bar plot of all encounters for patients with cCMV within our EMR, colored by the department in which the encounter occurred. For visualization, we have binned data along the x-axis on the basis of the listed age ranges. Abbreviations: Texas Children’s Hospital (TCH), Texas Children’s Pediatric Associates (TCPA)

Whisker Plot of Earliest Age that Deficits in Development are First Noted in cCMV

A whisker plot of the age (years) at which ICD-10 codes specific to developmental disorders are first noted in the EMR. The age at which a diagnosis was first noted is the difference in the first occurrence of an ICD-10 code in a chart reported and the patient’s date of birth. The horizontal box plots have been sorted by the ascending mean age at which problems were noted. ICD-10 codes occurring less frequently than in 5% of the sample have been suppressed.

Table of the Most Frequent Developmental Disorder ICD-10 Codes Billed for Patients with cCMV

List of ICD-10 billing diagnoses pertinent to disorders of development, which were associated with all encounters for children with cCMV across our healthcare system. This cohort comprised 771 person-years of follow up, with a mean of 6.9 years of follow-up per patient.

Conclusion

Both ScCMV and AcCMV are associated with sensory and developmental disabilities, most of which manifest in the first 2 years of life. EMR gives us the potential to study the many facets of cCMV in finer detail (e.g hearing loss) to identify rates of systems-based disease progression throughout time (Figure 3), and provide help with anticipatory guidance and generate cost-models for the true economic impact of cCMV.

Whisker Plot of Earliest Age that Hearing Deficits are Noted for Patients with cCMV

A whisker plot of the age (years) at which ICD-10 codes specific to hearing problems are first noted in the EMR. The age at which a diagnosis was first noted is the difference in the first occurrence of an ICD-10 code in a chart reported and the patient’s date of birth. Repeated measures across the cohort have been mitigated by keeping only the first time a code was noted in the patient’s chart. The horizontal box plots have been sorted by the ascending mean age at which problems were noted.

Disclosures

Ryan H. Rochat, MD, PhD, MS, Merck Sharpe & Dohme: Grant/Research Support Gail J. Demmler-Harrison, MD, Elsevier: Book royalties|Merck: Grant/Research Support|Microgen: Advisor/Consultant|Microgen: Grant/Research Support|Moderna: Advisor/Consultant|UpToDate Wolters Kluwer Health: Royalties.