Accuracy of international classification of diseases, ninth revision, codes for postpartum hemorrhage among women undergoing cesarean delivery
Accuracy of international classification of diseases, ninth revision, codes for postpartum hemorrhage among women undergoing cesarean delivery
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DOI：
10.1111/trf.14498
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发表时间：
2018-04-01
期刊：
影响因子：
2.9
通讯作者：
Escobar, Gabriel J.
中科院分区：
文献类型：
--
作者：
Butwick, Alexander J.;Walsh, Eileen M.;Escobar, Gabriel J.
确定国际疾病分类第九次修订版临床修改（ICD-9）产后出血（PPH）编码的准确性对于得出关于PPH流行病学的有效结论至关重要。我们的主要目标是评估ICD-9 PPH代码的性能特点，对参考标准，估计失血量（EBL）之间的一个队列接受剖腹产delivery.Study Design AND METHODS我们分析了产妇出院和EBL数据，从妇女谁接受剖腹产在凯撒永久北方加州设施在2010年和2013年之间。我们将PPH定义为至少1000 mL的EBL。在二次分析中，使用至少1500 mL的EBL对ICD-9性能特征进行评估，以分类重度PPH。以EBL至少1000 mL为金标准，PPH编码的敏感性为27.8%，特异性为97%，阳性预测值（PPV）为74.5%，阴性预测值（NPV）为80.9%。PPH代码的患病率（9%）低于使用至少1000 mL失血量的患病率（24%）。以EBL ≥ 1500 mL为参考标准，PPH编码的敏感性为61.7%，特异性为93.8%，PPV为34.2%，NPV为97.9%。结论PPH ICD-9编码的特异性高，PPV和NPV中等偏高，敏感性低。至少1500 mL的EBL作为参比标准品具有更高的灵敏度。我们的研究结果表明，对于接受剖腹产的妇女，需要努力提高质量，以提高PPH ICD-9编码的准确性，在行政数据集。
BACKGROUNDDetermining the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes for postpartum hemorrhage (PPH) is vital for reaching valid conclusions about the epidemiology of PPH. Our primary objectives were to assess the performance characteristics of ICD-9 PPH codes against a reference standard using estimated blood loss (EBL) among a cohort undergoing Cesarean delivery.STUDY DESIGN AND METHODSWe analyzed maternal discharge and EBL data from women who underwent Cesarean delivery at Kaiser Permanente Northern California facilities between 2010 and 2013. We defined PPH as an EBL of at least 1000mL. In a secondary analysis, ICD-9 performance characteristics were assessed using an EBL of at least 1500 mL to classify severe PPH.RESULTSWe identified 35,614 hospitalizations for Cesarean delivery. Using EBL of at least 1000 mL as the gold standard, PPH codes had a sensitivity of 27.8%, specificity of 97%, positive predictive value (PPV) of 74.5%, and a negative predictive value (NPV) of 80.9%. The prevalence of a PPH code (9%) was lower than the prevalence using a blood loss of at least 1000 mL (24%). Using a reference standard of EBL of at least 1500 mL, PPH codes had a sensitivity of 61.7%, specificity of 93.8%, PPV of 34.2%, and NPV of 97.9%.CONCLUSIONPPH ICD-9 codes have high specificity, moderately high PPVs and NPVs, and low sensitivity. An EBL of at least 1500 mL as a reference standard has higher sensitivity. Our findings suggest that, for women undergoing Cesarean delivery, quality improvement efforts are needed to enhance PPH ICD-9 coding accuracy in administrative data sets.