ICD-10-CM-Based Definitions for Emergency Department Opioid Poisoning Surveillance: Electronic Health Record Case Confirmation Study
ICD-10-CM-Based Definitions for Emergency Department Opioid Poisoning Surveillance: Electronic Health Record Case Confirmation Study
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DOI：
10.1177/0033354920904087
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发表时间：
2020-02-10
影响因子：
3.3
通讯作者：
Bunn, Terry L.
中科院分区：
文献类型：
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作者：
Slavova, Svetla;Quesinberry, Dana;Bunn, Terry L.
目的：有效的阿片类药物中毒发病率的定义是必不可少的国家监测的准确性。我们研究的目的是估计阳性预测值（PPV）的情况下定义确定急诊科（艾德）访问海洛因或其他阿片类药物中毒，使用计费记录与国际疾病分类，第十次修订，临床修改（ICD-10-CM）codes.Methods：我们检查了计费记录艾德访问4个医疗保健网络（12个ED）从2015年10月至2016年12月。我们对代表性样本进行了病历审查，以估计（1）首次列出的海洛因中毒诊断（n = 398），（2）继发性海洛因中毒诊断（n = 102），（3）首次列出的其他阿片类药物中毒诊断（n = 452），结果：首次海洛因中毒诊断的阳性预测值（PPV）为93.2%（95%CI，90.0%~ 96.3%），高于继发性海洛因中毒诊断的阳性预测值（PPV）（76.5%; 95%CI，68.1%~ 84.8%）。在其他阿片类药物中毒诊断中，首列诊断的PPV估计值为79.4%（95% CI，75.7%-83.1%），次要诊断的PPV估计值为67.0%（95% CI，57.8%-76.2%）。1055例病例中有867例（82.2%）接受了纳洛酮给药; 254例患者接受了多次给药。三分之一的患者有药物中毒史。药物测试下令只有354 cases.Conclusions：研究结果表明，海洛因或其他阿片类药物中毒监测定义，包括多个诊断（第一次上市和第二）将确定一个高比例的真阳性病例。
Objectives:Valid opioid poisoning morbidity definitions are essential to the accuracy of national surveillance. The goal of our study was to estimate the positive predictive value (PPV) of case definitions identifying emergency department (ED) visits for heroin or other opioid poisonings, using billing records with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes.Methods:We examined billing records for ED visits from 4 health care networks (12 EDs) from October 2015 through December 2016. We conducted medical record reviews of representative samples to estimate the PPVs and 95% confidence intervals (CIs) of (1) first-listed heroin poisoning diagnoses (n = 398), (2) secondary heroin poisoning diagnoses (n = 102), (3) first-listed other opioid poisoning diagnoses (n = 452), and (4) secondary other opioid poisoning diagnoses (n = 103).Results:First-listed heroin poisoning diagnoses had an estimated PPV of 93.2% (95% CI, 90.0%-96.3%), higher than secondary heroin poisoning diagnoses (76.5%; 95% CI, 68.1%-84.8%). Among other opioid poisoning diagnoses, the estimated PPV was 79.4% (95% CI, 75.7%-83.1%) for first-listed diagnoses and 67.0% (95% CI, 57.8%-76.2%) for secondary diagnoses. Naloxone was administered in 867 of 1055 (82.2%) cases; 254 patients received multiple doses. One-third of all patients had a previous drug poisoning. Drug testing was ordered in only 354 cases.Conclusions:The study findings suggest that heroin or other opioid poisoning surveillance definitions that include multiple diagnoses (first-listed and secondary) would identify a high percentage of true-positive cases.