van de Garde Ewoudt M W, Oosterheert Jan Jelrik, Bonten Marc, Kaplan Robert C, Leufkens Hubert G M
Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80082, 3506 TB Utrecht, The Netherlands.
J Clin Epidemiol. 2007 Aug;60(8):834-8. doi: 10.1016/j.jclinepi.2006.10.018. Epub 2007 Feb 23.
To estimate the sensitivity of International Classification of Diseases (ICD-9-CM) coding for detecting hospitalized community-acquired pneumonia and to assess possible determinants for misclassification.
Based on microbiological analysis data, 293 patients with a principal diagnosis of community-acquired pneumonia at seven hospitals in the Netherlands were assigned to three categories (pneumococcal pneumonia, pneumonia with other organism, or pneumonia with no organism specified). For these patients, the assigned principal and secondary ICD-9-CM codes in the hospital discharge record were retrieved and the corresponding sensitivity was calculated. Furthermore, pneumonia-related patient characteristics were compared between correctly and incorrectly coded subjects.
The overall sensitivity was 72.4% for the principal code and 79.5% for combined principal and secondary codes. For pneumococcal pneumonia (ICD-9-CM code 481) and pneumonia with specified organism (ICD-9-CM code 482-483), the sensitivities were 35% and 18.3%, respectively. Patient characteristics were not significantly different between correctly and incorrectly coded subjects except for duration of hospital stay, which correlated negatively with coding sensitivity (P=0.01).
ICD-9-CM codes showed modest sensitivity for detecting community-acquired pneumonia in hospital administrative databases, leaving at least one quarter of pneumonia cases undetected. Sensitivity decreased with longer duration of hospital stay.
评估国际疾病分类（ICD - 9 - CM）编码在检测住院社区获得性肺炎方面的敏感性，并评估可能导致错误分类的因素。
基于微生物学分析数据，荷兰七家医院中293例主要诊断为社区获得性肺炎的患者被分为三类（肺炎球菌肺炎、其他病原体所致肺炎或未明确病原体的肺炎）。对于这些患者，检索其医院出院记录中指定的主要和次要ICD - 9 - CM编码，并计算相应的敏感性。此外，对编码正确和错误的患者的肺炎相关特征进行了比较。
主要编码的总体敏感性为72.4%，主要和次要编码合并后的敏感性为79.5%。对于肺炎球菌肺炎（ICD - 9 - CM编码481）和明确病原体的肺炎（ICD - 9 - CM编码482 - 483），敏感性分别为35%和18.3%。除住院时间外，编码正确和错误的患者的特征没有显著差异，住院时间与编码敏感性呈负相关（P = 0.01）。
ICD - 9 - CM编码在医院管理数据库中检测社区获得性肺炎的敏感性一般，至少四分之一的肺炎病例未被检测到。敏感性随住院时间延长而降低。
