Pediatric Complex Chronic Conditions


The adult comorbidities defined by authors such as Charlson, Quan and Elixhuaser are not suitable for pediatric research. Feudtner and others produced comorbidity definitions suitable for infants and children, with mappings defined for both ICD-9 and ICD-10 codes (Feinstein et al. 2018; Feudtner et al. 2014). These are now included in the icd package for R, which enables fast calculation of comorbidities for PCCC and other ICD code to comorbidity maps.

Calculating PCCC comorbidities.

The PCCC comorbidities may be derived from both diagnostic and procedure codes. The following simulated data has both:

The data is in ‘wide’ format. icd no longer needs the data to be in ‘long’ format. The PCCC comorbidity classes can be computed directly from the source data and summarized in a plot. Here we calculate the PCCC from ICD diagnostic codes and ICD procedure codes separately, and logically combine them to get the result.

Let’s look at the summary results:


Feinstein, James A., Seth Russell, Peter E. DeWitt, Chris Feudtner, Dingwei Dai, and Tellen D. Bennett. 2018. “R Package for Pediatric Complex Chronic Condition Classification.” JAMA Pediatrics 172 (6): 596–98.

Feudtner, Chris, James A Feinstein, Wenjun Zhong, Matt Hall, and Dingwei Dai. 2014. “Pediatric Complex Chronic Conditions Classification System Version 2: Updated for ICD-10 and Complex Medical Technology Dependence and Transplantation.” BMC Pediatrics 14 (August): 199.