Searching for a needle in a haystack: Use of ICD-9-CM codes in drug-induced liver injury
Searching for a needle in a haystack: Use of ICD-9-CM codes in drug-induced liver injury
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DOI：
10.1111/j.1572-0241.2007.01456.x
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发表时间：
2007-11-01
影响因子：
9.8
通讯作者：
Fontana, Robert J.
中科院分区：
文献类型：
--
作者：
Jinjuvadia, Kartik;Kwan, Wendy;Fontana, Robert J.
目的：本研究的目的是使用计算机化管理数据库比较三种检索策略，以识别阿莫西林/克拉维酸、苯妥英、丙戊酸和异烟肼引起的特异质药物性肝损伤（DILI）病例。在搜索1中，对1994年至2004年期间使用ICD-9-CM编码的急性肝损伤患者的电子病历进行识别，在听写文本中搜索特定的药物名称。在检索2中，确定了所有ICD-9-CM编码为4种研究药物之一导致药物中毒/过量的患者。在检索3中，患者中毒代码以及急性肝损伤codesidentified.Results：审查的记录，从7,395搜索1患者产生51 DILI的情况下（0.7%）。相比之下，566例检索2例患者仅获得3例DILI病例（0.5%）。最后，搜索3提供了最大的特异性，但检测率低，只有两个病人（3.9%）有DILI由于四个drugs.Conclusion之一：急性肝损伤ICD-9-CM代码结合文字搜索的口述病历产生了最大数量的DILI的情况下，但具体比交叉急性肝损伤和中毒代码。使用ICD-9-CM代码来识别DILI等罕见不良事件仍然存在问题，并强调了前瞻性监测网络的必要性。
Objectives: The aim of our study was to compare three search strategies using a computerized administrative database to identify cases of idiosyncratic drug-induced liver injury (DILI) due to amoxicillin/clavulanic acid, phenytoin, valproic acid, and isoniazid.Methods: In search 1, electronic medical records from patients seen between 1994 and 2004 with an ICD-9-CM code of acute liver injury were identified and cross-searched for the specific drug names in the dictation text. In search 2, all patients with an ICD-9-CM code of drug poisoning/overdose due to one of the four study drugs were identified. In search 3, patients with a poisoning code as well as an acute liver injury code were identified.Results: Review of the records from the 7,395 search 1 patients yielded 51 DILI cases (0.7%). In contrast, the 566 search 2 patients yielded only three DILI cases (0.5%). Finally, search 3 provided the greatest specificity but a low rate of detection with only two patients (3.9%) having DILI due to one of the four drugs.Conclusion: Acute liver injury ICD-9-CM codes combined with a text search of the dictated medical record yielded the greatest number of DILI cases but was less specific than crossing acute liver injury and poisoning codes. Use of ICD-9-CM codes to identify rare adverse events like DILI remains problematic and highlights the need for prospective surveillance networks.