Accuracy of ICD Influenza Discharge Diagnosis Codes in Hospitalized Adults From the Valencia Region, Spain, in the Pre-COVID-19 Period 2012/2013 to 2017/2018

IF 4.2 4区医学 Q1 INFECTIOUS DISEASES

Influenza and Other Respiratory Viruses Pub Date : 2025-02-05 DOI:10.1111/irv.70069

Ainara Mira-Iglesias, Mónica López-Lacort, Hélène Bricout, Matthew Loiacono, Mario Carballido-Fernández, Joan Mollar-Maseres, Miguel Tortajada-Girbés, Germán Schwarz-Chávarri, F. Xavier López-Labrador, Joan Puig-Barberà, Javier Díez-Domingo, Alejandro Orrico-Sánchez

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Abstract

Background

International Classification of Diseases (ICD) codes obtained from real-world data can be used to identify influenza cases for epidemiological research but, without validation, may introduce biases. The objective of this study was to validate ICD influenza discharge diagnoses using real-time reverse transcription-polymerase chain reaction (RT-PCR) laboratory-confirmed influenza (LCI) results.

Methods

The study was conducted during six influenza seasons (2012/2013–2017/2018) in the Valencia Hospital Surveillance Network for the Study of Influenza (VAHNSI). Patients aged 18+ years were identified via active-surveillance and had to meet an influenza-like illness (ILI) case definition to be included. All patients were tested for influenza by real-time RT-PCR. Main and secondary influenza discharge diagnosis codes were extracted from hospital discharge letters. Positive predictive values (PPVs) and the complementary of the sensitivities (1-Sensitivity) of ICD codes with corresponding 95% credible intervals (CrIs) were estimated via binomial Bayesian regression models.

Results

A total of 13,545 patients were included, with 2257 (17%) positive for influenza. Of 2257 LCI cases, 1385 (61%) were not ICD-coded as influenza. Overall, 74.73% (95% CrI: 63.24–84.44) of LCI were not-ICD coded as influenza (1-Sensitivity) after adjustment. Sensitivity improved across seasons and with increasing age. Average PPV was 74.02% (95% CrI: 68.58–79.17), ranging from 43.71% to 81.57% between seasons.

Conclusion

Using only main and secondary discharge diagnosis codes for influenza detection markedly underestimates the full burden of influenza in hospitalized patients. Future studies, including post-COVID context, using prospective surveillance for ILI are required to assess the validity of hospital discharge data as a tool for determining influenza-related burden of disease.

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2012/2013年至2017/2018年2019冠状病毒病前期间西班牙瓦伦西亚地区住院成人ICD流感出院诊断代码的准确性

背景：从真实世界数据中获得的国际疾病分类代码可用于确定流行病学研究中的流感病例，但未经验证可能会引入偏差。本研究的目的是利用实时逆转录聚合酶链反应（RT-PCR）实验室确诊流感（LCI）结果验证ICD流感出院诊断。方法在瓦伦西亚医院流感研究监测网（VAHNSI）的6个流感季节（2012/2013-2017/2018）进行研究。通过主动监测确定年龄在18岁以上的患者，并且必须符合流感样疾病（ILI）病例定义才能纳入。所有患者均采用实时RT-PCR检测流感病毒。从医院出院信中提取主要和次要流感出院诊断代码。通过二项贝叶斯回归模型估计ICD编码的阳性预测值（ppv）和相应95%可信区间（CrIs）的灵敏度（1-灵敏度）的互补值。结果共纳入13545例患者，其中流感阳性2257例（17%）。在2257例LCI病例中，1385例（61%）未被icd编码为流感。总体而言，调整后74.73% （95% CrI: 63.24-84.44）的LCI未被icd编码为流感（1-敏感性）。敏感性随着季节和年龄的增长而提高。平均PPV为74.02% (95% CrI: 68.58 ~ 79.17)，季节间为43.71% ~ 81.57%。结论仅使用主要和次要出院诊断代码进行流感检测，明显低估了住院患者流感的全部负担。未来的研究，包括后covid背景下，需要使用流感感染的前瞻性监测来评估出院数据作为确定流感相关疾病负担工具的有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Influenza and Other Respiratory Viruses 医学-病毒学

CiteScore

7.20

自引率

4.50%

发文量

120

审稿时长

6-12 weeks

期刊介绍： Influenza and Other Respiratory Viruses is the official journal of the International Society of Influenza and Other Respiratory Virus Diseases - an independent scientific professional society - dedicated to promoting the prevention, detection, treatment, and control of influenza and other respiratory virus diseases. Influenza and Other Respiratory Viruses is an Open Access journal. Copyright on any research article published by Influenza and Other Respiratory Viruses is retained by the author(s). Authors grant Wiley a license to publish the article and identify itself as the original publisher. Authors also grant any third party the right to use the article freely as long as its integrity is maintained and its original authors, citation details and publisher are identified.