Comparison of International Classification of Diseases and Related Health Problems, Tenth Revision Codes With Electronic Medical Records Among Patients With Symptoms of Coronavirus Disease 2019
Comparison of International Classification of Diseases and Related Health Problems, Tenth Revision Codes With Electronic Medical Records Among Patients With Symptoms of Coronavirus Disease 2019
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DOI：
10.1001/jamanetworkopen.2020.17703
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发表时间：
2020-08-14
影响因子：
13.8
通讯作者：
Shah, Rashmee U.
中科院分区：
文献类型：
--
作者：
Crabb, Brendan T.;Lyons, Ann;Shah, Rashmee U.
疾病和相关健康问题国际统计分类第十次修订版 (ICD-10) 代码的重要性用于描述 2019 年冠状病毒病 (COVID-19) 相关症状的特征。它们的准确性未知，这可能会影响下游分析。目的 通过病历审查，比较接受过 COVID-19 检测的患者中发烧、咳嗽和呼吸困难特定 ICD-10 代码的表现。设计、设置和参与者 该队列研究包括 2020 年 3 月 10 日至 4 月 6 日在犹他大学健康中心接受严重急性呼吸综合征冠状病毒 2 型定量逆转录酶聚合酶链反应检测的患者。数据分析于 2020 年 4 月进行。 主要结果和措施 ICD-10 的敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV) 将发烧 (R50*)、咳嗽 (R05*) 和呼吸困难 (R06.0*) 的代码与人工病历审核进行比较。表现是根据 COVID-19 测试结果、性别、年龄组（64 岁）和住院状况进行总体计算和分层的。使用 Bootstrapping 生成 95% CI，并使用 Pearson chi(2) 检验来比较不同的亚组。结果 在接受 COVD-19 检测的 2201 名患者中，平均 (SD) 年龄为 42 (17) 岁； 1201 名（55%）为女性，1569 名（71%）为白人，282 名（13%）为西班牙裔或拉丁裔。发热患病率为66%（1444例患者），咳嗽患病率为88%（1930例患者），呼吸困难患病率为64%（1399例患者）。对于发热，ICD-10代码的敏感性为0.26（95% CI，0.24-0.29），特异性为0.98（95% CI，0.96-0.99），PPV为0.96（95% CI，0.93-0.97），NPV为0.41（95% CI，0.39-0.43）。对于咳嗽，ICD-10代码的敏感性为0.44（95% CI，0.42-0.46），特异性为0.88（95% CI，0.84-0.92），PPV为0.96（95% CI，0.95-0.97），NPV为0.18（95% CI，0.16-0.20）。对于呼吸困难，ICD-10代码的敏感性为0.24（95% CI，0.22-0.26），特异性为0.97（95% CI，0.96-0.98），PPV为0.93（95% CI，0.90-0.96），NPV为0.42（95% CI，0.96-0.96）。 0.40-0.44）。住院患者的 ICD-10 编码表现优于门诊患者的发热 (chi(2) = 41.30；P < .001) 和呼吸困难 (chi(2) = 14.25；P = .003)，但咳嗽 (chi(2) = 5.13；P = .16) 则不然。结论和相关性 这些研究结果表明，ICD-10 代码缺乏敏感性，并且对与 COVID-19 相关的症状的 NPV 较差。这种不准确性会对依赖这些代码的任何下游数据模型、科学发现或监测产生影响。问题国际疾病和相关健康问题统计分类第十次修订版 (ICD-10) 代码能否准确捕获接受 2019 年冠状病毒病 (COVID-19) 检测的患者中出现的发烧、咳嗽和呼吸困难症状？结果 在这项队列研究中，对 2020 年 3 月 10 日至 4 月 6 日期间接受过 COVID-19 检测的 2201 名患者进行了电子病历审查，发现 ICD-10 代码对于捕获发烧、咳嗽和呼吸困难的敏感性和阴性预测价值较差。意义 这些研究结果表明，症状特定的 ICD-10 代码不能准确捕获与 COVID-19 相关的症状，不应用于填充基于电子病历的队列中的症状。这项队列研究将针对发烧、咳嗽和呼吸困难的国际疾病分类和相关健康问题第十版 (ICD-10) 代码的性能与针对冠状病毒疾病测试的患者的电子病历审查进行了比较 2019 年（新冠肺炎 (COVID-19)）。
Importance International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes are used to characterize coronavirus disease 2019 (COVID-19)-related symptoms. Their accuracy is unknown, which could affect downstream analyses. Objective To compare the performance of fever-, cough-, and dyspnea-specific ICD-10 codes with medical record review among patients tested for COVID-19. Design, Setting, and Participants This cohort study included patients who underwent quantitative reverse transcriptase-polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 at University of Utah Health from March 10 to April 6, 2020. Data analysis was performed in April 2020. Main Outcomes and Measures The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ICD-10 codes for fever (R50*), cough (R05*), and dyspnea (R06.0*) were compared with manual medical record review. Performance was calculated overall and stratified by COVID-19 test result, sex, age group (64 years), and inpatient status. Bootstrapping was used to generate 95% CIs, and Pearson chi(2)tests were used to compare different subgroups. Results Among 2201 patients tested for COVD-19, the mean (SD) age was 42 (17) years; 1201 (55%) were female, 1569 (71%) were White, and 282 (13%) were Hispanic or Latino. The prevalence of fever was 66% (1444 patients), that of cough was 88% (1930 patients), and that of dyspnea was 64% (1399 patients). For fever, the sensitivity of ICD-10 codes was 0.26 (95% CI, 0.24-0.29), specificity was 0.98 (95% CI, 0.96-0.99), PPV was 0.96 (95% CI, 0.93-0.97), and NPV was 0.41 (95% CI, 0.39-0.43). For cough, the sensitivity of ICD-10 codes was 0.44 (95% CI, 0.42-0.46), specificity was 0.88 (95% CI, 0.84-0.92), PPV was 0.96 (95% CI, 0.95-0.97), and NPV was 0.18 (95% CI, 0.16-0.20). For dyspnea, the sensitivity of ICD-10 codes was 0.24 (95% CI, 0.22-0.26), specificity was 0.97 (95% CI, 0.96-0.98), PPV was 0.93 (95% CI, 0.90-0.96), and NPV was 0.42 (95% CI, 0.40-0.44). ICD-10 code performance was better for inpatients than for outpatients for fever (chi(2) = 41.30; P < .001) and dyspnea (chi(2) = 14.25; P = .003) but not for cough (chi(2) = 5.13; P = .16). Conclusions and Relevance These findings suggest that ICD-10 codes lack sensitivity and have poor NPV for symptoms associated with COVID-19. This inaccuracy has implications for any downstream data model, scientific discovery, or surveillance that relies on these codes.Question Do International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes accurately capture presenting symptoms of fever, cough, and dyspnea among patients being tested for coronavirus disease 2019 (COVID-19)? Findings In this cohort study, an electronic medical record review of 2201 patients tested for COVID-19 between March 10 and April 6, 2020, found that ICD-10 codes had poor sensitivity and negative predictive value for capturing fever, cough, and dyspnea. Meaning These findings suggest that symptom-specific ICD-10 codes do not accurately capture COVID-19-related symptoms and should not be used to populate symptoms in electronic medical record-based cohorts.This cohort study compares the performance of International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes specific for fever, cough, and dyspnea with electronic medical record review for patients tested for coronavirus disease 2019 (COVID-19).