Multicenter study of surveillance for hospital-onset Clostridium difficile infection by the use of ICD-9-CM diagnosis codes.
Multicenter study of surveillance for hospital-onset Clostridium difficile infection by the use of ICD-9-CM diagnosis codes.
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DOI：
10.1086/650447
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发表时间：
2010-03
影响因子：
4.5
通讯作者：
Prevention Epicenters Program of the Centers for Disease Control and Prevention
中科院分区：
文献类型：
--
作者：
Dubberke ER;Butler AM;Yokoe DS;Mayer J;Hota B;Mangino JE;Khan YM;Popovich KJ;Stevenson KB;McDonald LC;Olsen MA;Fraser VJ;Prevention Epicenters Program of the Centers for Disease Control and Prevention
比较通过国际疾病分类第九版临床修订版 (ICD-9) 诊断代码和电子可用的艰难梭菌毒素检测结果测量的医院发病艰难梭菌感染 (CDI) 发病率。 2000 年 7 月至 6 月 6 日期间，美国 5 家医院使用两种监测定义确定了院内发病的 CDI 病例：毒素检测结果阳性（金标准）和 CDI 的二级 ICD-9 诊断代码。卡方检验用于比较发病率，线性回归模型用于分析趋势，平等检验用于比较斜率。在 8,670 例院内发病的 CDI 病例中，38% 通过毒素检测和 ICD-9 代码两者确诊，16% 仅通过毒素检测确诊，45% 仅通过 ICD-9 代码确诊。仅通过 ICD-9 代码识别的 CDI 病例中，近一半 (47%) 是通过毒素检测发现的社区发病病例。与整体毒素检测相比（p < 0.001）以及 5 家医院中 3 家的单独检测（所有医院均 p < 0.001），ICD-9 代码的医院发病 CDI 率显着更高。毒素检测与 ICD-9 代码之间的一致性中等，总体 kappa 值为 0.509，医院特定 kappa 值范围为 0.489 至 0.570。总体而言，通过 ICD-9 代码确定的 CDI 发病率的年增长率明显高于通过毒素检测确定的总体发病率 (p = 0.006)。尽管 ICD-9 代码似乎足以衡量总体 CDI 负担，但使用入院分类时不存在的艰难梭菌 ICD-9 代码并不是院内发病 CDI 监测可接受的替代方法。
To compare hospital-onset C. difficile infection (CDI) incidence rates measured by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9) diagnosis codes and electronically available C. difficile toxin assay results. Hospital-onset CDI cases were identified at 5 U.S. hospitals between 07/00-06/06 using 2 surveillance definitions: positive toxin assay results (gold standard) and secondary ICD-9 diagnosis codes for CDI. Chi-square tests were used to compare incidence rates, linear regression models to analyze trends, and the test of equality to compare slopes. Of 8,670 hospital-onset CDI cases, 38% were identified by both toxin assay and ICD-9 code, 16% by toxin assay alone, and 45% by ICD-9 code alone. Nearly half (47%) of CDI cases identified by ICD-9 code alone were community-onset cases by toxin assay. The hospital-onset CDI rate was significantly higher by ICD-9 codes compared to toxin assays overall (p < 0.001), as well as individually at 3 of the 5 hospitals (p < 0.001 for all). The agreement between toxin assays and ICD-9 codes was moderate, with an overall kappa value of 0.509 and hospital-specific kappa values that ranged from 0.489 to 0.570. Overall, the annual increase in CDI incidence was significantly greater for rates determined by ICD-9 codes than by toxin assays overall (p = 0.006). Although ICD-9 codes appear to be adequate for measuring the overall CDI burden, use of the C. difficile ICD-9 code without presence on admission classification are not an acceptable surrogate for hospital-onset CDI surveillance.
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