Use of ICD-10 Codes for Identification of Injection Drug Use-Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder.
Use of ICD-10 Codes for Identification of Injection Drug Use-Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder.
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DOI：
10.1093/ofid/ofaa414
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发表时间：
2020-10
影响因子：
4.2
通讯作者：
Durkin MJ
中科院分区：
文献类型：
--
作者：
Marks LR;Nolan NS;Jiang L;Muthulingam D;Liang SY;Durkin MJ
没有《国际疾病分类》第十版（ICD-10），存在注射用药相关感染性心内膜炎（IDU-IE）的诊断代码。相反，公共卫生研究人员经常使用非特异性ICD-10代码的组合来识别IDU-IE；然而，这些代码的准确性尚未得到评估。我们将常用的ICD-10 IDU-IE诊断代码与在Barnes-Jewish医院前瞻性收集的IDU-IE诊断患者队列进行比较，以确定IDU-IE研究中使用的ICD-10诊断代码的准确性。历史上用于识别IDU-IE的ICD-10诊断代码是不准确的，在该队列中，遗漏36.0%的患者，错误分类56.4%的患者。这些非特异性ICD-10诊断代码的使用导致了对阿片类药物使用障碍（mod）药物治疗与AMA出院和全因死亡率相关的益处的实质性偏见。具体来说，当使用ICD-10代码组合提示IDU-IE的所有患者的数据时，mod与AMA出院风险增加相关（相对风险[RR]， 1.12; 95% CI, 0.48-2.64）。相比之下，当仅分析经图表回顾证实有IDU-IE的患者时，mod具有保护作用（RR, 0.49; 95% CI, 0.19-1.22）。在Kaplan-Meier分析中，仅当对确诊的IDU-IE病例进行分析时，mod的使用与全因死亡率的保护作用相关（P = .007）。使用非特异性ICD-10诊断代码进行IDU-IE的研究应谨慎解释。在持续的过量危机和传染性并发症综合征的背景下，迫切需要为IDU-IE制定一个特定的ICD-10诊断代码。
No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use–associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48–2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19–1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (P = .007). Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed.
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影响因子：
39.2
作者：
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通讯作者：
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影响因子：
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影响因子：
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