Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Clin Microbiol Infect. 2010 Jun;16(6):715-21. doi: 10.1111/j.1469-0691.2009.02867.x. Epub 2009 Jul 15.
Co-morbid illnesses have a major influence on the epidemiology of infectious diseases. Although International Classification of Diseases (ICD) discharge codes are frequently used to evaluate the presence of co-morbidities in observational research, additional research is required about their validity. We reviewed the evidence supporting the use of routinely coded administrative data for ascertainment of co-morbid diseases with emphasis as it relates to the study of infectious diseases. A systematic Medline, Embase, and bibliographic review were conducted in order to identify and critically appraise published (1990-2008) studies comparing administrative databases with conventional chart review. Twenty-one co-morbidities commonly associated with infectious diseases risk were a priori selected for specific evaluation. Of the 21 co-morbid conditions chosen, only 19 had adequate data available for evaluation. Thirteen studies were included; only one focused on an infectious disease population. Eleven articles validated individual co-morbid conditions data in electronic administrative databases and reported a wide range of pooled sensitivity (13-82%) but overall high pooled specificity (>97%) when compared with medical chart review. Seven articles compared Charlson Co-morbidity Index scores derived from administrative data algorithms as compared with that calculated from medical record review and found that administrative data underscored the index in all articles with kappa agreement ranging from 0.30 to 0.56. The small body of literature published to date suggests that electronic administrative databases have limited validity for co-morbidity evaluation. Studies evaluating administrative database ascertainment of co-morbidities specifically in infectious diseases research are needed.
合并症对传染病的流行病学有重大影响。尽管国际疾病分类（ICD）出院代码常用于观察性研究中评估合并症的存在，但还需要进一步研究其有效性。我们回顾了支持使用常规编码的行政数据来确定合并疾病的证据，重点是与传染病研究相关的证据。为了确定并批判性评价发表的（1990-2008 年）比较行政数据库与常规图表审查的研究，我们进行了系统的 Medline、Embase 和文献综述。选择了 21 种与传染病风险相关的常见合并症进行专门评估。在选择的 21 种合并症中，只有 19 种有足够的数据可供评估。共纳入 13 项研究，只有 1 项专注于传染病人群。11 篇文章验证了电子行政数据库中个体合并症数据的有效性，并报告了广泛的汇总敏感性（13%-82%），但总体汇总特异性（>97%）均高于与医疗图表审查相比。7 篇文章比较了从行政数据算法中得出的 Charlson 合并症指数评分与从医疗记录审查中计算得出的评分，发现行政数据在所有文章中都强调了该指数，kappa 一致性范围从 0.30 到 0.56。迄今为止发表的文献数量较少，表明电子行政数据库在合并症评估方面的有效性有限。需要在传染病研究中评估行政数据库确定合并症的研究。
