Evaluation of the predictive value of ICD-9-CM coded administrative data for venous thromboembolism in the United States
Evaluation of the predictive value of ICD-9-CM coded administrative data for venous thromboembolism in the United States
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DOI：
10.1016/j.thromres.2010.03.009
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发表时间：
2010-07-01
影响因子：
7.5
通讯作者：
Romano, Patrick S.
中科院分区：
文献类型：
--
作者：
White, Richard H.;Garcia, Martina;Romano, Patrick S.
目的：确定国际疾病分类第9版临床修订版的阳性预测值材料和方法：回顾性分析了2005年至2007年期间住院的3456例静脉血栓栓塞出院病例，使用3个样本人群：一个单一的学术医院，33个大学健康系统联盟医院，和35个社区医院在一个国家联合委员会的研究。结果：在1096例血栓栓塞代码位于主要位置的病例中，任何急性静脉血栓形成的阳性预测值为95%（95% CI：93-97），而在2360例继发位置有血栓栓塞代码的病例中，预测值较低，为75%（95% CI：71-80）。下肢深静脉血栓形成或肺栓塞的相应阳性预测值分别为91%（95%CI：86-95）和50%（95%CI：41-58）。定义越高的编码预测值越高。在第二位置的假阳性代码中，22%（95% CI：16-27）有慢性/既往静脉血栓形成，15%（95% CI：10-19）有上肢血栓形成，6%（95% CI：4-8）有浅静脉血栓形成，7%（95%CI：4-13）未提及任何血栓形成。ICD-9-CM编码对静脉血栓栓塞的预测价值在主要位置时较高，在次要位置时较低。2009年增加的新血栓栓塞代码规定了慢性血栓形成、上肢血栓形成和浅静脉血栓形成，应减少假阳性血栓栓塞代码的频率。(C)2010爱思唯尔有限公司保留所有权利。
Objective: To determine the positive predictive value of International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) discharge codes for acute deep vein thrombosis or pulmonary embolism.Materials and Methods: Retrospective review of 3456 cases hospitalized between 2005 and 2007 that had a discharge code for venous thromboembolism, using 3 sample populations: a single academic hospital, 33 University HealthSystem Consortium hospitals, and 35 community hospitals in a national Joint Commission study. Analysis was stratified by position of the code in the principal versus a secondary position.Results: Among 1096 cases that had a thromboembolism code in the principal position the positive predictive value for any acute venous thrombosis was 95% (95% CI: 93-97), whereas among 2360 cases that had a thromboembolism code in a secondary position the predictive value was lower, 75% (95% CI: 71-80). The corresponding positive predictive values for lower extremity deep-vein thrombosis or pulmonary embolism were 91% (95% CI: 86-95) and 50% (95% CI: 41-58), respectively. More highly defined codes had higher predictive value. Among codes in a secondary position that were false positive, 22% (95% CI: 16-27) had chronic/prior venous thrombosis, 15% (95% CI: 10-19) had an upper extremity thrombosis, 6% (95% CI: 4-8) had a superficial vein thrombosis, and 7% (95% CI: 4-13) had no mention of any thrombosis.Conclusions: ICD-9-CM codes for venous thromboembolism had high predictive value when present in the principal position, and lower predictive value when in a secondary position. New thromboembolism codes that were added in 2009 that specify chronic thrombosis, upper extremity thrombosis and superficial venous thrombosis should reduce the frequency of false-positive thromboembolism codes. (C) 2010 Elsevier Ltd. All rights reserved.