It began - I don't want to say "innocently," so perhaps "innocuously" - on SOAPM with a post from a clever PCC client:
We all know we have seen a lot of strep. Just ran our numbers. Jan-June of 2022, we had 62 streptococcal sore throats. Jan-June 2023 we had 860. So that's where all the amoxicillin went.
Interesting. Then, a few other PCC clients weighed in. In fact, it was only PCC clients who shared data, each exclaiming the same result - I guess having a good reporting system pays off :-) but it's more like we tend to attract the nerds. Good for them, good for us. But now I needed to know...are pediatricians, in fact, seeing more strep?
There are about 25 ICD-10 codes that refer to strep, but only a handful with any meaningful volume:
A49.1 Streptococcal infection, unspecified site B95.0 Streptococcus, group A, as the cause of diseases classified elsewhere B95.3 Streptococcus pneumoniae as the cause of diseases classified elsewhere B95.5 Unspecified streptococcus as the cause of diseases classified elsewhere J02.0 Streptococcal pharyngitis J03.00 Acute streptococcal tonsillitis, unspecified J03.01 Acute recurrent streptococcal tonsillitis
To put this in perspective, the J02.0 code is most commonly used for strep diagnosis and our clients used it more than 350K times from 2019 through mid 2023. Whereas we had a single recorded instance of O99.820 ("Streptococcus B carrier state complicating pregnancy"). Although there are surely important clinical patterns in the lower-volume diagnoses that someone should examine, this isn't rigorous enough work to do that. Plus, we're looking at the tidal-wave issues. We're looking just at the codes above.
Let's take a look at some pictures. Here's a review of the absolute volume of these codes over the last 4.5 years:
It's hard to miss: your J02.0 [maroon] volume is ~2-4x higher than you have ever seen (2019 was a banner year itself) with a massive, continued uptick in strep diagnoses. There's also a notable increase in streptococcal tonsillitis [light blue]. Historically, strep is a 'January' thing, but you've sustained a 5-month power run in 2023 - June is also high, but all the data isn't in yet for me to include it.
It's important to consider relative volumes as well. Your waiting rooms may be filled with sore throats, but are the less-common strep diagnoses also on an uptick? Let's look at the volume relative to the average month of 2019.
That little upswing in tonsillitis is really a 10x increase! For each of the strep diagnoses except the B95.3 (Streptococcus pneumoniae as the cause of diseases classified elsewhere), there is a marked increase in volume since September.
Anyone else seeing and feeling this?