验证国际疾病分类代码 (ICD) 第 10 次修订版算法,以准确识别肺栓塞。

IF 5.5 2区 医学 Q1 HEMATOLOGY
Behnood Bikdeli, Candrika D Khairani, Antoine Bejjani, Ying-Chih Lo, Shiwani Mahajan, César Caraballo, Jose Victor Jimenez, Darsiya Krishnathasan, Mehrdad Zarghami, Sina Rashedi, David Jimenez, Stefano Barco, Eric A Secemsky, Frederikus A Klok, Andetta R Hunsaker, Ayaz Aghayev, Alfonso Muriel, Mohamad A Hussain, Abena Appah-Sampong, Yuan Lu, Zhenqiu Lin, Hamid Mojibian, Sanjay Aneja, Rohan Khera, Stavros Konstantinides, Samuel Z Goldhaber, Liqin Wang, Li Zhou, Manuel Monreal, Gregory Piazza, Harlan M Krumholz
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引用次数: 0

摘要

背景:许多有关肺栓塞(PE)的研究调查都依赖于国际疾病分类第 10 次修订版(ICD-10)代码对电子数据库进行分析。ICD-10 代码在识别肺栓塞方面的有效性仍不确定:采用预先指定的方案,对麻省总布里格姆医院(2016-2021年)中有ICD-10 PE主要出院代码的患者、有PE次要代码的患者和无PE代码的患者进行鉴定(每组N=578)。采用加权法使各组的代表性与其真实患病率成比例。将 ICD-10 编码识别 PE 的准确性与独立医生的判定进行了比较。评估了包含灵敏度和阳性预测值 (PPV) 的 F1 分数。在耶鲁-纽黑文医疗系统进行了子集验证:共纳入 1712 名患者(年龄:60.6 岁,52.3% 为女性)。主要出院位置的 ICD-10 PE 代码的灵敏度和 PPV 分别为 58.3% 和 92.1%。在主要出院代码中加入次要出院代码可将灵敏度提高至 83.2%,但 PPV 则降至 79.1%。使用 ICD-10 PE 主要出院代码或辅助代码加 PE 影像代码的组合,灵敏度和 PPV 分别为 81.6% 和 84.7%,F1 得分最高(83.1%,PConclusions:虽然 PE 的主要出院代码显示出极佳的 PPV,但却漏诊了 40% 的急性 PE。结合使用主要出院代码、次要代码和 PE 影像代码可提高灵敏度,但不会严重降低 PPV。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Validating International Classification of Diseases Code 10th Revision algorithms for accurate identification of pulmonary embolism.

Background: Many research investigations for pulmonary embolism (PE) rely on the International Classification of Diseases 10th Revision (ICD-10) codes for analyses of electronic databases. The validity of ICD-10 codes in identifying PE remains uncertain.

Objectives: The objective of this study was to validate an algorithm to efficiently identify pulmonary embolism using ICD-10 codes.

Methods: Using a prespecified protocol, patients in the Mass General-Brigham hospitals (2016-2021) with ICD-10 principal discharge codes for PE, those with secondary codes for PE, and those without PE codes were identified (n = 578 from each group). Weighting was applied to represent each group proportionate to their true prevalence. The accuracy of ICD-10 codes for identifying PE was compared with adjudication by independent physicians. The F1 score, which incorporates sensitivity and positive predictive value (PPV), was assessed. Subset validation was performed at Yale-New Haven Health System.

Results: A total of 1712 patients were included (age: 60.6 years; 52.3% female). ICD-10 PE codes in the principal discharge position had sensitivity and PPV of 58.3% and 92.1%, respectively. Adding secondary discharge codes to the principal discharge codes improved the sensitivity to 83.2%, but the PPV was reduced to 79.1%. Using a combination of ICD-10 PE principal discharge codes or secondary codes plus imaging codes for PE led to sensitivity and PPV of 81.6% and 84.7%, respectively, and the highest F1 score (83.1%; P < .001 compared with other methods). Validation yielded largely similar results.

Conclusion: Although the principal discharge codes for PE show excellent PPV, they miss 40% of acute PEs. A combination of principal discharge codes and secondary codes plus PE imaging codes led to improved sensitivity without severe reduction in PPV.

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来源期刊
Journal of Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis 医学-外周血管病
CiteScore
24.30
自引率
3.80%
发文量
321
审稿时长
1 months
期刊介绍: The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.
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