UKZN Academics Devise New Diagnosis Model

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Two UKZN Lecturers have developed a new model - the NJ Model - to determine the most appropriate principal diagnosis for a patient with multiple principal diagnoses.

They are Dr Nnabuike Chibuoke Ngene of the Department of Obstetrics and Gynaecology, and Professor Jagidesa Moodley.  Their study is titled: “Assigning Appropriate and Comprehensive Diagnosis for Scientific Report”.

Ngene said assigning one principal diagnosis to a patient with multiple diagnoses tends to conceal the overall clinical condition of such a patient.

‘The use of currently available guidelines such as the International Classification of Diseases' 10th Revision (ICD-10) and its clinical modification  (ICD-10-CM) to assign a principal diagnosis to a patient who has multiple principal diagnoses, appears unreliable,’ he said.

‘This is because these guidelines are complex and use highly subjective criteria.  Even when one main diagnosis is selected, the comprehensive list of other diseases that the patient has is often not reported such that the overall clinical condition of the patient is obscured,’said Ngene.

The study also showed how to report the main principal diagnosis and all other diagnoses when writing a scientific report.

ICD-10 and ICD-10-CM are the criteria generally used to assign one principal diagnosis to a patient with multiple diagnoses.

These already existing / approved guidelines resort to early use of criteria that are subjective. According to Ngene, this makes the main principal diagnosis selected with ICD-10 or ICD-10-CM less reproducible.

He said the NJ model was developed using clinical/pathologic criteria and was therefore likely to generate a more reproducible main principal diagnosis.

According to Ngene the NJ model is a significant breakthrough that may be used to revise ICD-10, which is used internationally. The model was developed using the intuitive abilities of the authors.

Ngene said the model was supported by empirical case reports included in their publication.

‘During data collection for our research among pregnant women admitted to critical care units in public hospitals in Pietermaritzburg, we discovered how difficult it was to use ICD-10 to assign one principal diagnosis to patients with multiple diagnoses,’ he said.

The authors believe the NJ model should be used to revise the ICD-10 and the ICD-10-CM.

Ngene said that assigning the most appropriate/reproducible one principal diagnosis to patients with multiple diagnoses was very important. ‘This will have impact on health policies based on reported frequency of diseases. In addition, by reporting the main principal diagnosis and all other diagnoses of patients in a scientific paper, the overall clinical condition of that patient group will be better described,’ he explained.

Nigerian-born Ngene is a consultant Obstetrician and Gynaecologist at Edendale Hospital in Pietermaritzburg.

Moodley, an Emeritus Professor at UKZN, is a great teacher, mentor and renowned researcher.

Ngene holds two specialist qualifications in Family Medicine as well as Obstetrics and Gynaecology. He has had papers published in 11 peer reviewed journals in the last two years and does reviews for six international journals.

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