Prev… Top of Article

FULL TEXT ARTICLE

Prevalence of malignant
hyperthermia diagnosis in
hospital discharge records in
California, Florida, New York,

Source
and Wisconsin  
Zhen Lu, Henry Rosenberg and Guohua Li
Journal of Clinical Anesthesia, 2017-06-01, Volume 39, Pages 10-14,
Copyright © 2017 Elsevier Inc.

Abstract
Study objective
Malignant hyperthermia (MH) is a rare yet
potentially fatal pharmacogenetic disorder triggered
by exposure to inhalational anesthetics and the
depolarizing neuromuscular blocking agent
succinylcholine. Epidemiologic data on the
geographic variation in MH prevalence is scant. The
objective of this study is to examine the prevalence
of recorded MH diagnosis in patients discharged
from hospitals in four states in the United States.

Design
Observational study.

Setting
Healthcare Cost and Utilization Project (HCUP)
State Inpatient Database (SID) for California (2011),
Florida (2011), New York (2012) and Wisconsin
(2012).

Patients
A total of 164 hospital discharges that had a
recorded diagnosis of MH using the International
Classification of Disease, 9th Revision, Clinical
Modification code 995.86.

Methods
MH prevalence was assessed by patient
demographic and clinical characteristics.

Main results
The prevalence of MH per 100,000 hospital
discharges ranged from 1.23 (95% Confidence
Interval [CI], 0.80–1.66) in New York to 1.91 (95%
CI, 1.48–2.34) in California, and the prevalence of
MH per 100,000 surgical discharges ranged from
1.47 (95% CI, 0.93–2.02) in New York to 2.86 (95%
CI, 2.00–3.71) in Florida. The prevalence of MH in
male patients was more than twice the prevalence in
female patients. Of the 164 patients with MH
diagnosis, 11% were dead on discharge.

Conclusions
There exists a modest variation in the prevalence of
recorded MH diagnosis in hospital discharges in
California, Florida, New York and Wisconsin.
Epidemiologic patterns of MH diagnosis in hospital
discharges appear to be similar across the four
states. Further research is needed to better
understand the geographic variation and
contributing factors of MH in different populations.

Highlights
• There is anecdotal evidence for excess risk of
malignant hyperthermia (MH) in Florida and
Wisconsin.

• Epidemiologic data on the geographic variation

in MH prevalence are scant.

• Statewide data for the year 2011/2012 indicate

that the prevalence of MH per 100,000 hospital
discharges was 1.2 in New York, 1.6 in Wisconsin,
1.8 in Florida, and 1.9 in California.

• Epidemiologic patterns of recorded MH

diagnosis in hospital discharges are similar across
the states.

1 Introduction
Malignant Hyperthermia (MH) is an autosomal-
dominant genetic disorder of the skeletal muscle, in
many cases linked to mutations in RYR1 and
CACNA1S genes [1 2] . This pharmacogenetic clinical
syndrome is triggered by sensitivity to volatile
inhalational anesthetic gases (e.g., sevoflurane,
desflurane, isoflurane, etc.) and the depolarizing
neuromuscular blocking agent succinylcholine,
leading to skeletal muscle hypermetabolism [3] .
Epidemiologic data on MH are scant in the U.S. The
prevalence of MH due to anesthetics is estimated to
range from 1 per 16,000 in Denmark [4] to 1 per
100,000 in New York State [5] . MH is reported to
affect all racial groups though regional variation of
prevalence in MH susceptibility and prevalence have
been noted worldwide [1 4 5 6 7 . The true
prevalence of MH is hard to define due to
unrecognized mild or aborted reactions, and the
variable penetrance of the inherited susceptibility
[8] .

The prevalence of MH in hospital discharges across

the United States has been estimated to be
approximately 1 per 100,000 [5,8,9]. Factors
associated with elevated MH risk include male sex,
young age, several myopathies and congenital
anomalies [5 9 10] . MH susceptibility as diagnosed
with a caffeine-halothane contracture has been
documented in patients with heat stroke and
exercise-induced rhabdomylosis 11 12 13 14 .

There is little information on the epidemiological

pattern of MH across geographic regions in the
United States. There is anecdotal evidence for excess
MH risk in Florida [15] and Wisconsin [14] . In
particular, it has been reported that residents of
north-central Wisconsin may have higher MH
susceptibility [16] . However, there have been no
epidemiologic studies examining the prevalence of
MH in these specific states. The purpose of this
study is to better understand the epidemiology of
MH in the United States by estimating the
prevalence of MH diagnosis and characterize factors
associated with MH diagnosis recorded in a large
sample of inpatient database in four states located in
different US geographic regions, including
California in the West, Florida in the South, New
York in the Northeast, and Wisconsin in the
Midwest.

2 Materials and methods

This study meets the criteria for the Protection of
Human Subjects exemption 4 (research involving
pre-existing data) of the U.S. Code of Federal
Regulations (45 CFR 46.101). The study was deemed
exempt from review by the institutional review
board's Administrative Review Committee at the
Columbia University Medical Center (New York,
New York).

2.1 Data source

Data for this study came from the Healthcare Cost
and Utilization Project (HCUP) State Inpatient
Database (SID) for California (2011), Florida (2011),
New York (2012) and Wisconsin (2012) (most
recently available data at the time of the study),
which are composed of annual, state-specific files
that share uniform structure and data elements that
facilitate cross-state comparisons [17] . The SID
contains inpatient discharge records from within a
state, including abstracts from community hospitals
and non-community hospitals. Community
hospitals, as defined by the American Hospital
Association (AHA), include “all nonfederal, short-
term, general and other specialty hospitals,
excluding hospital units of institutions”. Non-
community hospitals include federal hospitals, long-
term hospitals, psychiatric hospitals,
alcohol/chemical dependency treatment facilities
and hospital units within institutions such as
prisons [18] . The database contains clinical and
nonclinical information on all patients including
patient diagnoses and procedures, admission and
discharge status, patient demographics (e.g., gender,
age, and race), payment source (Medicare, Medicaid,
private insurance, and uninsured) and some hospital
characteristics. The SID are discharge-level (not
patient) files in which each record represents one
inpatient visit. The Agency for Healthcare Research
and Quality aggregates ICD-9-CM diagnostic coding
into meaningful clinical groups: the Clinical
Classification Software (CCS) codes [19] .

2.2 Study sample

The study sample consisted of all inpatient
discharges in California during 2011, Florida during
2011, New York during 2012, and Wisconsin during
2012. MH cases were identified by screening all the
discharge diagnoses using the ICD-9-CM code
995.86 to indicate MH events as well as MH
susceptibility. We calculated the prevalence of MH
based on two denominators: (1) all hospital
discharges; (2) hospital discharge with a surgical
ICD-9 procedure code listed [20] . The two risk
groups were not mutually exclusive.

2.3 Statistical analysis

Prevalence of MH due to anesthesia was calculated
based on all inpatient discharges in the SID for four
states. MH prevalence in hospital and surgical
discharges among four states was examined
according to patient demographic characteristics
including age, sex, admission type and comorbid
conditions. Comorbidities were identified by
applying the Charlson Comorbidity Score to ICD-9-
CM codes in the datasets [21 22] . Descriptive
statistics such as 95% confidence interval (CI) and
standard errors were calculated using inpatient
discharges from each state as the denominator and
MH discharges of each state as the numerator.
Comparisons of prevalence among different patient
groups were performed with SAS version 9.4 (SAS
Institute, Cary, NC) using χ 2 test to compare
categorical variables. Statistical significance was
defined as P < 0.05 with Bonferroni correction for
multiple comparisons.

3 Results
3.1 Prevalence
The SID for all four states contained a total of
9,745,539 inpatient discharge records, including 164
having an MH diagnosis. The overall prevalence of
MH was 1.68 (95% CI, 1.42–1.94) per 100,000
hospital discharges and 2.37 (95% CI, 1.99–2.75) per
100,000 surgical discharges. Higher MH prevalence
was observed in surgical discharges compared to
hospital discharges across all four states ( Fig. 1 ).
The prevalence of MH diagnosis did not differ
significantly across the states for all hospital
discharges ( P > 0.90) and for surgical discharges ( P
= 0.16) ( Fig. 1 ). California had the highest
prevalence of MH diagnosis for all hospital
discharges (1.91 per 100,000; 95% CI, 1.48–2.34)
while Florida had the highest prevalence of MH
diagnosis for surgical discharges (2.86 per 100,000;
95% CI, 2.00–3.71) ( Fig. 1 ).

Fig. 1
Prevalence and standard error of malignant hyperthermia
(MH) per 100,000 discharges by state and denominator
type.

The prevalence of MH was significantly higher in

males and young adults than in females and older
adults, respectively ( Table 1 ). The prevalence of MH
per 100,000 hospital discharges was similar across
racial groups ( Table 1 ). The prevalence of MH for
surgical discharges was 5.8 times (95% CI, 3.33–
9.95) that for non-surgical discharges ( Table 1 ).

Table 1
Prevalence and 95% confidence intervals of malignant
hyperthermia by patient characteristics in California (2011),
Florida (2011), New York (2012) and Wisconsin (2012).

Patient Number of Number of Prevalence 95%

characteristics hospital hospital per CI

discharges discharges 100,000

with MH hospital

diagnosis discharges

Age (years) a

< 18 1,572,888 24 1.53 0.92–

2.14

18–44 2,443,065 54 2.21 1.62–

2.80

45–64 2,378,401 45 1.89 1.34–

2.45

65 + 3,320,001 41 1.24 0.86–

1.61

Sex a

Male 4,150,875 99 2.39 1.92–

2.86

Female 5,499,335 64 1.16 0.88–

1.45

Race a

White 5,320,307 92 1.73 1.38–

2.08

Black 1,246,455 15 1.20 0.59–

1.81

Hispanic 1,934,058 32 1.66 1.08–

2.23

Other 903,077 16 1.77 0.90–

2.64

Charlson-Deyo comorbidity index

0 6,112,735 103 1.69 1.36–

2.01

1+ 3,632,804 61 1.68 1.26–

2.10

Admission type b

Emergency/Urgent 4,139,074 58 1.40 1.04–

1.76

Elective 1,671,294 30 1.80 1.15–

2.44

Surgical procedure c

Present 6,339,807 150 2.37 1.99–

2.75

Absent 3,405,732 14 0.41 0.20–

0.63

Vital status at discharge a

Dead 186,547 18 9.65 5.19–

14.11

Alive 9,558,551 146 1.53 1.28–

1.78

State

California 3,933,239 75 1.91 1.48–

2.34

Florida 2,656,249 48 1.81 1.30–

2.32

New York 2,529,422 31 1.23 0.80–

1.66

Wisconsin 626,629 –d 1.60 0.61–

2.59

CI = Confidence Interval; MH = Malignant Hyperthermia.

a There were 31,184 (0.003%) discharges with

missing/inconsistent/invalid information on Age;
95,329 (0.01%) discharges and one case with
missing information on Sex; 341,642 (0.04%)
discharges with missing/inconsistent/invalid
information and 9 cases on Race; 441 (< 0.0001%)
discharges with missing/invalid information on
Vital status at discharge.

b Data as shown only indicate Admission Type for

Florida, New York, and Wisconsin. California SID
does not have variable indicating Admission Type.
There were 1932 (< 0.001%) discharges and 1 case
with missing/invalid information on Admission
Type.

c Clinical Classification Software (CCS) is used to

aggregate clinical procedure categories. This system
is clinically based on ICD-9-CM codes.

d These data are not presented as the report of data

for any subgroup with 10 or fewer subjects is
prohibited by the Healthcare Cost and Utilization
Project State Inpatient Databases data use
agreement.

The variable indicating any exposure to anesthesia

was only available for New York. In New York State
alone, the prevalence of MH was 4.52 (95% CI,
2.06–6.98) per 100,000 discharges exposed to
general anesthesia, 0.27 (95% CI, 0.00–0.79) per
100,000 discharges exposed to other anesthesia
including local and regional anesthesia, and 0.88
(95% CI, 0.36–1.40) per 100,000 discharges
exposed to no anesthesia (data not shown).

3.2 Characteristics of MH cases

Of the 164 patients with a diagnosis of MH, 47.6%
were aged 44 years or younger with the median age
of 46.5 years, 59.4% were white, 60.7% were male,
and 91.5% were surgical discharges ( Table 1 ).
Among the four states studied, California did not
collect data on the type of admission (emergency,
urgent, elective, etc.). For the three other states,
65.9% of cases with an MH diagnosis were admitted
as emergency or urgent types. Based on the
Charlson-Deyo Comorbidity Score ≥ 1, 37.2% of the
MH cases had at least one significant pre-existing
medical condition ( Table 1 ). Of all the hospital
discharges, the prevalence of MH did not differ
significantly by patient race, Charlson-Deyo
Comorbidity Index and admission type ( Table 1 ). It
was shown that among patient discharges recorded
with MH diagnosis, 11.0% were dead on discharge (
Table 1 ).

Multivariable logistic regression analyses identified

age, sex, and state as significant and independent
factors associated with prevalence of MH diagnosis
for the first denominator, all hospital discharges (
Table 2 ). However, for the second denominator,
surgical discharges only, after adjusting for sex and
state, age was not found to be independently
associated with prevalence of MH diagnosis ( Table 2
). For both denominators, California had
significantly higher prevalence of MH diagnosis than
New York and males had significantly higher
prevalence of MH diagnosis than female ( Table 2 ).

Table 2
Adjusted odds ratios (AORs) and 95% confidence intervals
(CI) of malignant hyperthermia diagnosis associated with
state, age and sex.

Variable AOR (95% CI) AOR (95% CI)

(hospital discharge data) (surgical discharge data a )

States

California Reference Reference

Florida 0.94 (0.65–1.36) 1.04 (0.71–1.52)

New York 0.62 (0.41–0.95) 0.54 (0.35–0.83)

Wisconsin 0.83 (0.43–1.61) 0.86 (0.43–1.73)

Age b

< 18 Reference Reference

18–44 1.86 (1.14–3.05) 1.14 (0.69–1.88)

45–64 1.31 (0.79–2.17) 1.08 (0.64–1.81)

65 + 0.89 (0.53–1.49) 0.72 (0.42–1.22)

Sex b

Female Reference Reference

Male 2.26 (1.63–3.11) 2.18 (1.57–3.04)

OR = Odds Ratio; CI = Confidence Interval.

a Clinical Classification Software (CCS) is used to

aggregate clinical procedure categories. This system
is clinically based on ICD-9-CM codes.

b There were 31,184 (0.003%) discharges with

missing/inconsistent/invalid information on Age;
and 95,329 (0.01%) discharges with missing
information on Sex.

4 Discussion
Geographic differences in prevalence of MH
susceptibility have been reported in previous studies
[4 23 24] . However, to our knowledge, there has been
no report on geographic variations in the prevalence
of MH in the Unites States. The results of this study
indicate that the prevalence of recorded MH
diagnosis in hospital discharges appears to be
comparable across the four states studied. The
prevalence of MH diagnosis (including both
prevalent and incident cases) based on surgical
discharges across the four states was higher
compared to the results reported in previous studies.
In previous studies, the prevalence of MH in
hospital surgical patients was found to be
approximately 1 per 100,000 in New York State [5]
and 1.3 patients per 100,000 in the United States [9]
. In the present study, the highest prevalence of MH
diagnosis in surgical discharges was found in Florida
and the lowest prevalence in New York. The higher
prevalence of MH reported in the present study
compared to earlier studies might be attributed to
increased awareness of MH and improved accuracy
of MH coding in the inpatient setting.

Consistent with prior studies of the inpatient

population, the age group for patients with the
highest prevalence of MH in the inpatient setting is
< 45 years old [1 9 25] . Compared to a previous study
in which the median age was 22.0 years for very
likely or almost certain MH cases, the median age of
46.5 years as observed in our study could be
attributed to both MH incidence and MH
susceptible cases being recorded in the datasets.
Similar to previous studies, the prevalence rates of
MH in hospital discharges did not differ significantly
by patient race, admission type, and the Charlson-
Deyo Comorbidity Index [4 5] . This study is
consistent with previous reports that have found
higher incidence of MH in males than females [5 9
25 26] . The mortality rate of 11% reported in our
study is similar to those reported in prior studies [3
9] .

After adjusting for age and sex, the odds of

prevalence of MH diagnosis for surgical discharges
is 5.8 times (95% CI, 3.33–9.95) the odds for non-
surgical discharges, most likely due to exposure to
general anesthesia during the procedure. As shown
in this study, in New York alone, the prevalence of
MH diagnosis for discharges exposed to general
anesthesia is much higher than those exposed to
other anesthesia or no anesthesia. However, this
explanation could not be generalized to the other
states since information on exposure to anesthesia
in hospital discharge records is only available in the
New York data set.

A previous report showed that residents of north-

central Wisconsin have had higher incidence of MH
[16] ; our study shows that the prevalence of MH
diagnosis in hospital discharges of Wisconsin is
similar to the other three states. However, the
prevalence rate of MH in Wisconsin in this study
only used one year of data. Further examination of
more years of inpatient data of Wisconsin or cross-
examining with The North American Malignant
Hyperthermia Registry might represent a more
accurate prevalence rate of MH in Wisconsin.

Our study has several limitations. First, the SIDs do

not contain variables that allow us to differentiate
incident MH events from visits where patients have
a family history of MH or documented MH
susceptibility. ICD-9 codes are likely to be more
accurate for calculating disease prevalence than for
calculating disease incidence, as incidence requires
identification of new cases or cases without previous
documentation [27] . The prevalence of MH as found
in this study represents the combined cases of
incidence and MH susceptible individuals during
their stay in the inpatient setting. Currently, the ICD
system does not have the coding capacity to
differentiate an incident MH episode from a positive
MH history or susceptibility. It is both desirable and
sensible to add a separate code for MH history or
susceptibility to the ICD system. Before the coding
for MH is refined, a useful approach to differentiate
incident MH cases from patients with MH
susceptibility is to review medical charts for patients
with a recorded diagnosis of MH in combination
with ICD codes [28] . Also, additional codes for
detailed information on anesthesia such as
administration of dantrolene during surgical
procedures could be added to the SID as this would
help differentiate incident MH cases from MH
susceptibility diagnosis.

Second, the accuracy and completeness of MH

diagnosis and coding may vary across hospitals and
states. Based on a recent study, the most common
reason for inaccurate MH coding for hospital
discharge records is due to high fever unrelated to
anesthesia [28] . The study also finds that prevalence
of MH susceptibility is more likely to be captured
accurately by ICD-9-CM code than MH incidence
[28] , implying that by using administrative
databases such as the SIDs, the MH prevalence
found in our study could be reflecting a higher
proportion of MH susceptible cases rather than MH
incidence.

Third, patient information on anesthesia, admission

schedule, and admission type were not available for
all four states. Without indication of anesthesia
recorded in the datasets, it was impossible to
compare the prevalence rate of MH in this risk-
group with prior studies. In addition, MH patients
who were transferred from other health care
facilities such as ambulatory surgery centers and
died in the emergency room before admission to the
hospitals were not captured in the SIDs.

Finally, the datasets for the four states were not

drawn from the same year because more recent data
for California and Florida were unavailable at the
time of the study, and this discrepancy might
somewhat affect the compatibility of MH prevalence
across the four states. It is also important to note
that the lack of statistical significance in the
difference in MH prevalence across the four states is
due in part to the modest sample size of recorded
MH diagnoses and limited study power. Out of the
four states, California was the only state with an MH
diagnostic biopsy center in 2011. It is unknown to
what degree the presence of the diagnostic biopsy
center may have impacted the prevalence of
recorded MH diagnosis in California as information
about the number of MH biopsies performed in the
diagnostic biopsy center was unavailable in the SID.

Despite these limitations, the large sample size of

the SID enables epidemiological analyses of a rare
medical condition such as MH across different
geographic regions. Among inpatient discharges in
the four states, the overall prevalence of MH
diagnosis found in this study is consistent with
results of earlier studies. These data should help to
understand the geographic distribution of MH
susceptible individuals in four of the most populated
states in United States.

Disclosure
Disclosure
This study was supported in part by the Malignant
Hyperthermia Association of the United States,
Sherburne, NY, and by Grant 1 R49 CE002096 from
the National Center for Injury Prevention and
Control, Centers for Disease Control and Prevention
to the Center for Injury Epidemiology and
Prevention at Columbia University. Its contents are
solely the responsibility of the authors and do not
necessarily represent the official views of the
Centers for Disease Control and Prevention. The
funders had no role in the conduct of the research or
the preparation of this article.

Acknowledgments
We thank Barbara Lang for her editorial and
administrative assistance.

References
1. Rosenberg H., Davis M., James D., Pollock N.,
Stowell K.: Malignant hyperthermia. Orphanet J
Rare Dis 2007; 2: pp. 21.
View In Article Cross Ref

2. Carpenter D., Ringrose C., Leo V., Morris A.,

Robinson R., Halsall P., et. al.: The role of
CACNA1S in predisposition of malignant
hyperthermia. BMC Med Genet 2009; 10: pp. 104.
View In Article Cross Ref

3. Torpy J.M., Lynm C., Glass R.M.: Malignant

hyperthermia. JAMA 2005; 293: pp. 2958.
View In Article Cross Ref

4. Ørding H.: Incidence of malignant

hyperthermia in Denmark. Anesth Analg 1985;
64: pp. 700-707.
View In Article

5. Brady J.E., Sun L.S., Rosenberg H., Li G.:

Prevalence of malignant hyperthermia due to
anesthesia in New York State, 2001–2005. Anesth
Analg 2009; 109: pp. 1162-1167.
View In Article Cross Ref

6. Sumitani M., Uchida K., Yasunaga H.,

Horiguchi H., Kusakabe Y., Matsuda S., et. al.:
Prevalence of malignant hyperthermia and
relationship with anesthetics in Japan: data from
the diagnosis procedure combination database.
Anesthesiology 2001; 114: pp. 84-90.
View In Article

7. Da Silva H.C., Almeida Cdos S., Brandão J.C.,

Nogueira e Silva C.A., de Lorenzo M.E., Ferreira
C.B., et. al.: Malignant hyperthermia in Brazil:
analysis of hotline activity in 2009. Braz J
Anesthesiol 2013; 63: pp. 13-19.
View In Article

8. Litman R., Rosenberg H.: Malignant

hyperthermia: an update on susceptibility testing.
JAMA 2005; 293: pp. 2918-2924.
View In Article Cross Ref

9. Rosero E.B., Adesanya A.O., Timaran C.H.,

Joshi G.P.: Trends and outcomes of malignant
hyperthermia in the United States, 2000 to 2005.
Anesthesiology 2009; 110: pp. 89-94.
View In Article

10. Li G., Brady J.E., Rosenberg H., Sun L.S.:

Excess comorbidities associated with malignant
hyperthermia diagnosis in pediatric hospital
discharge records. Pediatr Anesth 2011; 9: pp.
958-963.
View In Article

11. Tobin J.R., Jason D.R., Challa V.R., Nelson

T.E., Sambuughin N.: Malignant hyperthermia
and apparent heat stroke. JAMA 2001; 286: pp.
168-169.
View In Article Cross Ref

12. Bendahan D., Kozak-Ribbens G., Confort-

Gouny S., Ghattas B., Figarella-Branger D., Aubert
M., et. al.: A noninvasive investigation of muscle
energetics supports similarities between
exertional heat stroke and malignant
hyperthermia. Anesth Analg 2001; 93: pp. 683-
689.
View In Article Cross Ref

13. Wappler F., Fiege M., Steinfath M., Agarwal

K., Scholz J., Singh S., et. al.: Evidence for
susceptibility to malignant hyperthermia in
patients with exercise-induced rhabdomyolysis.
Anesthesiology 2001; 94: pp. 95-100.
View In Article Cross Ref

14. Rosenberg H., Rothstein A.: Malignant

hyperthermia death holds many lessons. APSF
Newsletter 2006; 21: pp. 32-34.
View In Article

15. Malignant Hyperthermia Update. Available at:

[accessed 2016.06.16] https://www.fsahq.org/patient-
information/malignant-hyperthermia/
View In Article

16. McPherson E.W., Taylor C.A.: The genetics of

malignant hyperthermia: evidence for
heterogeneity. Am J Med Genet 1982; 11: pp. 273-
285.
View In Article Cross Ref

17. Overview of the State Inpatient Databases

(SID). [accessed 2016.06.16] Available at
https://www.hcup-us.ahrq.gov/sidoverview.jsp#about
View In Article

18. HCUP State Inpatient Databases (SID) File

Composition — Number of Hospitals by Year.
[accessed 2016.06.16] Available at:
https://www.hcup-
us.ahrq.gov/db/state/siddist/siddist_hospital.jsp
View In Article

19. Elixhauser A., Steiner C., Palmer L.: Clinical

Classifications Software (CCS), 2004.2004.U.S.
Agency for Healthcare Research and
QualityRockville, MD (Report # 2004-02)
View In Article

20. Agency for Healthcare Research and Quality.

AHRQ Quality Indicators: Patient Safety
Indicators—Technical
Specifications.2008.Department of Health and
Human Services, Agency for Healthcare Research
and QualityRockville (MD)
View In Article

21. Deyo R.A., Cherkin D.C., Ciol M.A.: Adapting a

clinical comorbidity index for use with ICD-9-CM
administrative databases. J Clin Epidemiol 1992;
45: pp. 613-619.
View In Article Cross Ref

22. Quan H., Sundararajan V., Halfon P., Fong A.,

Burnand B., Luthi J.C., et. al.: Coding algorithms
for defining comorbidities in ICD-9-CM and ICD-
10 administrative data. Med Care 2005; 43: pp.
1130-1139.
View In Article Cross Ref

23. Bachand M., Vachon N., Boisvert M., Mayer

F.M., Chartrand D.: Clinical reassessment of
malignant hyperthermia in Abitibi-
Temiscamingue. Can J Anaesth 1997; 44: pp. 696-
701.
View In Article

24. Kalow W., Britt B.A., Terreau M.E., Haist C.:

Metabolic error of muscle metabolism after
recovery from malignant hyperthermia. Lancet
1970; 2: pp. 895-898.
View In Article

25. Larach B.G., Brandom B.W., Allen G.C.,

Gronert G.A., Lehman E.B.: Malignant
hyperthermia deaths related to inadequate
temperature monitoring, 2007–2012: a report
from the North American Malignant
Hyperthermia Registry of the Malignant
Hyperthermia Association of the United States.
Anesth Analg 2014; 119: pp. 1359-1366.
View In Article

26. Larach M.G., Gronert G.A., Allen G.C.,

Brandom B.W., Lehman E.B.: Clinical
presentation, treatment, and complications of
malignant hyperthermia in North America from
1987 to 2006. Anesth Analg 2010; 110: pp. 498-
507.
View In Article

27. O'Malley K., Cook K., Price M., Wildes K.,

Hurdle J., Ashton C.: Measuring diagnoses: ICD
code accuracy. Health Serv Res 2005; 40: pp.
1620-1639.
View In Article Cross Ref

28. Pinyavat T., Rosenberg H., Lang B.H., Wong

C.A., Riazi S., Brady J.E., et. al.: Accuracy of
malignant hyperthermia diagnoses in hospital
discharge records. Anesthesiology 2015; 122: pp.
55-63.
View In Article

Previous Article Next Article

         

Contact Us

Resource Center

Terms & Conditions

Privacy Policy

Registered User Agreement

Help

Accessibility

We use cookies to help provide and enhance our service

and tailor content. By continuing you agree to the use of
cookies.
Copyright © 2023 Elsevier B.V. or its licensors or
contributors.