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AFHSC Surveillance Case Definitions
FINAL January 2015
Case Definition and Incidence Rules
For surveillance purposes, a case of uterine leiomyomas or “fibroids” is defined as:
One hospitalization or outpatient medical encounter with any of the defining diagnoses
of uterine leiomyomas (see ICD9 and ICD10 code lists below) in the primary
diagnostic position; or
One hospitalization or outpatient medical encounter with any of the defining diagnoses
of uterine leiomyomas (see ICD9 and ICD10 code lists below) in the secondary
diagnostic position; AND at least one associated symptom (see ICD9 and ICD10 code
lists below) in the primary diagnostic position.
Incidence rules:
For individuals who meet the case definition:
The incidence date is considered the date of the first hospitalization or outpatient
medical encounter that includes a defining diagnosis of uterine leiomyomas.
An individual is considered an incident case only once per lifetime.
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UTERINE LEIOMYOMAS (FIBROIDS)
Background
This case definition was developed by the Armed Forces Health Surveillance Center (AFHSC) for the
purpose of epidemiological surveillance of a condition important to military-associated populations. In
the U.S. Armed Forces in 2010, “uterine leiomyoma” (ICD9 code: 218) was the 5 th most frequent
diagnosis during hospitalizations for active component females, and the 2nd most frequent diagnosis
during ambulatory visits for neoplasms.
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,
2
Clinical Description
Uterine leiomyomas, or “fibroids”, are benign, often asymptomatic tumors of the uterus that occur
frequently in premenopausal women. Symptomatic fibroids can cause appreciable morbidity and
disability in affected women; common symptoms include heavy, painful menstrual bleeding, pelvic
pain, urinary frequency, and reproductive difficulties. Treatments for symptomatic fibroids vary
according to the size, location, and number of fibroids, the severity of symptoms, and the patient’s
desire to retain reproductive ability. Therapeutic options range from watchful waiting and drug therapy
to surgical procedures such as hysterectomy (removal of the uterus) and myomectomy (removal of the
fibroid).
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1
Armed Forces Health Surveillance Center. Hospitalizations among members of the active component,
U.S. Armed Forces, 2010. Medical Surveillance Monthly Report (MSMR). 2011; 18(4): 8-15.
2
Armed Forces Health Surveillance Center. Ambulatory visits among members of the active component,
U.S. Armed Forces, 2010. Medical Surveillance Monthly Report (MSMR). 2011; 18(4): 16-21.
3
Armed Forces Health Surveillance Center. Uterine fibroids, active component females, U.S. Armed
Forces, 2001-2010. Medical Surveillance Monthly Report (MSMR). 2011; 18(12): 10-13.
