Hougland Paul, Xu Wu, Pickard Steve, Masheter Carol, Williams Scott D
Utah Department of Health, Salt Lake City, UT 84114, USA.
Med Care. 2006 Jul;44(7):629-36. doi: 10.1097/01.mlr.0000215859.06051.77.
Adverse drug events (ADEs) are one of the most frequent causes of iatrogenic injury. Because International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes are routinely assigned to inpatient discharges, they could provide a method to detect ADEs within a hospital, a state, and the nation.
The objective of this study was to determine validity of selected ICD-9-CM codes in identifying inpatient ADEs.
An expert panel identified 416 ICD-9-CM codes to represent ADEs (flagged ADE codes). Retrospective chart review using a structured tool was performed to ascertain code performance in detecting ADEs.
Subjects included 3103 inpatients from all 41 acute care hospitals in Utah in 2001: 1961 inpatients sampled randomly (random sample) and 1142 inpatients sampled from the discharge records with at least one flagged ADE code (flagged sample).
Measures were ADEs identified by structured review.
The flagged sample yielded 1122 flagged ADE codes recorded in patient charts with 704 representing ADEs (63%). Two hundred eighty-six of the 704 verified ADE codes (41%) were determined to be inpatient ADEs. In the random sample, 32 of 58 ADEs (55%) causing hospital admission were detected by the ADE-flagged codes. Only 23 of 224 inpatient ADEs had been assigned a flagged ADE code (10%).
Flagged ADE codes have an overall positive predictive value of 63% and detect just over half of ADEs causing hospital admission. These codes have a positive predictive value of 25% for inpatient ADEs but detect only 10% of overall inpatient ADEs. Flagged ADE codes provide an imperfect but immediately available ADE surveillance system.
药物不良事件（ADEs）是医源性损伤最常见的原因之一。由于国际疾病分类第九版临床修订本（ICD - 9 - CM）编码通常会被分配到住院患者的出院记录中，它们可以提供一种在医院、州和全国范围内检测ADEs的方法。
本研究的目的是确定选定的ICD - 9 - CM编码在识别住院患者ADEs方面的有效性。
一个专家小组确定了416个ICD - 9 - CM编码来代表ADEs（标记的ADE编码）。使用结构化工具进行回顾性病历审查，以确定编码在检测ADEs方面的表现。
研究对象包括2001年犹他州41家急性护理医院的3103名住院患者：1961名随机抽样的住院患者（随机样本）和1142名从至少有一个标记的ADE编码的出院记录中抽样的住院患者（标记样本）。
测量指标是通过结构化审查确定的ADEs。
标记样本在患者病历中产生了1122个标记的ADE编码，其中704个代表ADEs（63%）。704个经核实的ADE编码中有286个（41%）被确定为住院患者ADEs。在随机样本中，导致住院的58个ADEs中有32个（55%）通过ADE标记编码被检测到。224个住院患者ADEs中只有23个被分配了标记的ADE编码（10%）。
标记的ADE编码总体阳性预测值为63%，能检测出略多于一半的导致住院的ADEs。这些编码对住院患者ADEs的阳性预测值为25%，但仅能检测出总体住院患者ADEs的10%。标记的ADE编码提供了一个不完善但立即可用的ADE监测系统。
