Chang Douglas C, Burwell Lauren A, Lyon G Marshall, Pappas Peter G, Chiller Tom M, Wannemuehler Kathleen A, Fridkin Scott K, Park Benjamin J
Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Infect Control Hosp Epidemiol. 2008 Jan;29(1):25-30. doi: 10.1086/524324.
Administrative data, such as International Classification of Diseases, Ninth Revision (ICD-9) codes, are readily available and are an attractive option for surveillance and quality assessment within a single institution or for interinstitutional comparisons. To understand the usefulness of administrative data for the surveillance of invasive aspergillosis, we compared information obtained from a system based on ICD-9 codes with information obtained from an active, prospective surveillance system, which used more extensive case-finding methods (Transplant Associated Infection Surveillance Network).
Patients with suspected invasive aspergillosis were identified by aspergillosis-related ICD-9 codes assigned to hematopoietic stem cell transplant recipients and solid organ transplant recipients at a single hospital from April 1, 2001, through January 31, 2005. Suspected cases were classified as proven or probable invasive aspergillosis by medical record review using standard definitions. We calculated the sensitivity and positive predictive value (PPV) of identifying invasive aspergillosis by individual ICD-9 codes and by combinations of codes.
The sensitivity of code 117.3 was modest (63% [95% confidence interval {CI}, 38%-84%]), as was the PPV (71% [95% CI, 44%-90%]); the sensitivity of code 117.9 was poor (32% [95% CI, 13%-57%]), as was the PPV (15% [95% CI, 6%-31%]). The sensitivity of codes 117.3 and 117.9 combined was 84% (95% CI, 60%-97%); the PPV of the combined codes was 30% (95% CI, 18%-44%). Overall, ICD-9 codes triggered a review of medical records for 64 medical patients, only 16 (25%) of whom had proven or probable invasive aspergillosis.
A surveillance system that involved multiple ICD-9 codes was sufficiently sensitive to identify most cases of invasive aspergillosis; however, the poor PPV of ICD-9 codes means that this approach is not adequate as the sole tool used to classify cases. Screening ICD-9 codes to trigger a medical record review might be a useful method of surveillance for invasive aspergillosis and quality assessment, although more investigation is needed.
行政数据，如国际疾病分类第九版（ICD-9）编码，很容易获取，是单个机构内进行监测和质量评估或机构间比较的一个有吸引力的选择。为了解行政数据在侵袭性曲霉病监测中的有用性，我们将基于ICD-9编码系统获得的信息与通过更广泛病例发现方法（移植相关感染监测网络）的主动前瞻性监测系统获得的信息进行了比较。
2001年4月1日至2005年1月31日期间，在一家医院通过分配给造血干细胞移植受者和实体器官移植受者的与曲霉病相关的ICD-9编码来识别疑似侵袭性曲霉病患者。通过使用标准定义的病历审查将疑似病例分类为确诊或可能的侵袭性曲霉病。我们计算了通过单个ICD-9编码以及编码组合识别侵袭性曲霉病的敏感性和阳性预测值（PPV）。
编码117.3的敏感性一般（63%[95%置信区间{CI}，38%-84%]），PPV也是如此（71%[95%CI，44%-90%]）；编码117.9的敏感性较差（32%[95%CI，13%-57%]），PPV也是如此（15%[95%CI，6%-31%]）。编码117.3和117.9组合后的敏感性为84%（95%CI，60%-97%）；组合编码的PPV为30%（95%CI，18%-44%）。总体而言，ICD-9编码促使对64名内科患者的病历进行审查，其中只有16名（25%）确诊或可能患有侵袭性曲霉病。
一个涉及多个ICD-9编码的监测系统对识别大多数侵袭性曲霉病病例具有足够的敏感性；然而，ICD-9编码的PPV较差意味着这种方法不足以作为分类病例的唯一工具。筛选ICD-9编码以触发病历审查可能是侵袭性曲霉病监测和质量评估的一种有用方法，尽管还需要更多研究。
