Zhan Chunliu, Battles James, Chiang Yen-Pin, Hunt David
Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD, USA.
Jt Comm J Qual Patient Saf. 2007 Jun;33(6):326-31. doi: 10.1016/s1553-7250(07)33037-7.
Deep vein thrombosis and pulmonary embolism (DVT/PE) are common complications after surgery and are associated with substantial excess mortality and length of stay. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes recorded in hospital claims have been used to identify and study DVT/PE, but the validity of this method is not well studied.
Identification of postoperative DVT/PE events were compared using ICD-9-CM codes and medical record abstraction in random samples of hospital discharges of Medicare beneficiaries in 2002-2004.
Among 20,868 eligible surgical hospitalizations, 232 DVT cases and 95 PE cases were identified by ICD-9-CM codes; 108 DVT cases and 31 PE cases by medical record abstraction; 72 DVT cases and 23 PE cases by both methods. The resulting estimates of PPV of ICD9-CM coding were 31% (72/232 cases) for DVT, 24% (23/95) for PE, and 29% (90/308) for DVT/PE combined. The resulting sensitivity estimates were 67% (72/108 cases) for DVT, 74% (23/31) for PE, and 68% (90/133) for DVT/PE combined.
ICD-9-CM codes in Medicare claims are sensitive but have limited predictive validity in identifying postoperative DVT/PE. Improvements in the validity are needed before the indicator can be used for safety performance assessment.
深静脉血栓形成和肺栓塞（DVT/PE）是手术后常见的并发症，与显著的额外死亡率和住院时间延长相关。医院索赔记录中的国际疾病分类第九版临床修订本（ICD-9-CM）编码已被用于识别和研究DVT/PE，但这种方法的有效性尚未得到充分研究。
在2002 - 2004年医疗保险受益人的医院出院随机样本中，使用ICD-9-CM编码和病历摘要比较术后DVT/PE事件的识别情况。
在20,868例符合条件的外科住院病例中，通过ICD-9-CM编码识别出232例DVT病例和95例PE病例；通过病历摘要识别出108例DVT病例和31例PE病例；两种方法均识别出72例DVT病例和23例PE病例。ICD9-CM编码的阳性预测值估计结果为：DVT为31%（72/232例），PE为24%（23/95），DVT/PE合并为29%（90/308）。敏感性估计结果为：DVT为67%（72/108例），PE为74%（23/31），DVT/PE合并为68%（90/133）。
医疗保险索赔中的ICD-9-CM编码在识别术后DVT/PE方面具有敏感性，但预测有效性有限。在该指标可用于安全绩效评估之前，需要提高其有效性。
