Multisite medical record review of emergency department visits for traumatic brain injury.

IF 2
Barbara A Gabella, Jeanne E Hathaway, Beth Hume, Jewell Johnson, Julia F Costich, Svetla Slavova, Ann Y Liu
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引用次数: 6

Abstract

Background: In 2016, the CDC in the USA proposed codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for identifying traumatic brain injury (TBI). This study estimated positive predictive value (PPV) of TBI for some of these codes.

Methods: Four study sites used emergency department or trauma records from 2015 to 2018 to identify two random samples within each site selected by ICD-10-CM TBI codes for (1) intracranial injury (S06) or (2) skull fracture only (S02.0, S02.1-, S02.8-, S02.91) with no other TBI codes. Using common protocols, reviewers abstracted TBI signs and symptoms and head imaging results that were then used to assign certainty of TBI (none, low, medium, high) to each sampled record. PPVs were estimated as a percentage of records with medium-certainty or high-certainty for TBI and reported with 95% confidence interval (CI).

Results: PPVs for intracranial injury codes ranged from 82% to 92% across the four samples. PPVs for skull fracture codes were 57% and 61% in the two university/trauma hospitals in each of two states with clinical reviewers, and 82% and 85% in the two states with professional coders reviewing statewide or nearly statewide samples. Margins of error for the 95% CI for all PPVs were under 5%.

Discussion: ICD-10-CM codes for traumatic intracranial injury demonstrated high PPVs for capturing true TBI in different healthcare settings. The algorithm for TBI certainty may need refinement, because it yielded moderate-to-high PPVs for records with skull fracture codes that lacked intracranial injury codes.

外伤性脑损伤急诊就诊的多地点医疗记录回顾
背景:2016年,美国疾病预防控制中心(CDC)提出了《国际疾病分类第十版临床修改》(ICD-10-CM)中用于识别创伤性脑损伤(TBI)的编码。本研究估计了其中一些编码的阳性预测值(PPV)。方法:4个研究点使用2015 - 2018年的急诊科或创伤记录,在每个研究点随机选择2个样本,使用ICD-10-CM TBI代码(1)颅内损伤(S06)或(2)颅骨骨折(S02.0, S02.1-, S02.8-, S02.91),没有其他TBI代码。使用通用方案,审稿人提取TBI体征和症状以及头部成像结果,然后使用这些结果为每个采样记录分配TBI的确定性(无、低、中、高)。ppv以TBI中确定性或高确定性记录的百分比估计,并以95%置信区间(CI)报告。结果:颅内损伤码的ppv在四个样本中从82%到92%不等。在两个州的两所大学/创伤医院中,有临床评审员的颅骨骨折代码的ppv分别为57%和61%,在两个州的专业编码器中,有82%和85%的人审查全州或几乎全州的样本。所有ppv的95% CI误差范围小于5%。讨论:外伤性颅内损伤的ICD-10-CM代码显示,在不同的医疗保健环境中,高ppv用于捕获真正的TBI。TBI确定性的算法可能需要改进,因为对于缺乏颅内损伤编码的颅骨骨折记录,它产生了中等到高的ppv。
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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