Johnston I D, Bleasdale C, Hind C R, Woodcock A A
University Hospital, Nottingham.
Thorax. 1991 Aug;46(8):589-91. doi: 10.1136/thx.46.8.589.
To determine the accuracy of diagnostic coding of cryptogenic fibrosing alveolitis, the case notes of 166 admissions to four hospitals were reviewed. These consisted of all admissions that had been coded as "idiopathic fibrosing alveolitis" (ICD code 516.3: 97 admissions) or as "postinflammatory pulmonary fibrosis" (ICD code 515.9: 69 admissions). Of 88 available records of admissions coded as idiopathic fibrosing alveolitis, 70 (80%) patients had definite cryptogenic fibrosing alveolitis, and six (7%) possible cryptogenic fibrosing alveolitis according to predetermined conventional clinical criteria. Only seven (8%) admissions were clearly coded wrongly. Sixty four records were available for patients coded as having postinflammatory pulmonary fibrosis; 16 (25%) of these patients had definite cryptogenic fibrosing alveolitis, a further 12 (19%) had possible cryptogenic fibrosing alveolitis or fibrosing alveolitis with a connective tissue disorder, and the remainder had a very wide range of diagnoses. In this study the idiopathic fibrosing alveolitis (ICD 516.3) code was relatively reliable, but a substantial proportion of admissions coded under postinflammatory pulmonary fibrosis (ICD 515.9) also had cryptogenic fibrosing alveolitis and code 515.9 was of little diagnostic value. The data are inadequate for case finding, though in respect of cryptogenic fibrosing alveolitis may be adequate for planning purposes. There continues to be a need for more medical input into the process of diagnostic coding.
为确定隐源性纤维性肺泡炎诊断编码的准确性，我们查阅了四家医院166例入院病例的病历。这些病例包括所有被编码为“特发性纤维性肺泡炎”（国际疾病分类代码516.3：97例）或“炎症后肺纤维化”（国际疾病分类代码515.9：69例）的入院病例。在88份可获取的被编码为特发性纤维性肺泡炎的入院记录中，根据预先确定的传统临床标准，70例（80%）患者患有明确的隐源性纤维性肺泡炎，6例（7%）可能患有隐源性纤维性肺泡炎。只有7例（8%）入院病例的编码明显错误。有64份被编码为患有炎症后肺纤维化患者的记录；其中16例（25%）患者患有明确的隐源性纤维性肺泡炎，另有12例（19%）可能患有隐源性纤维性肺泡炎或伴有结缔组织疾病的纤维性肺泡炎，其余患者的诊断范围非常广泛。在本研究中，特发性纤维性肺泡炎（国际疾病分类516.3）代码相对可靠，但在炎症后肺纤维化（国际疾病分类515.9）编码下的相当一部分入院病例也患有隐源性纤维性肺泡炎，代码515.9的诊断价值不大。这些数据对于病例发现来说并不充分，不过就隐源性纤维性肺泡炎而言，可能足以用于规划目的。在诊断编码过程中，仍然需要更多的医学投入。
