Juhn Young, Kung Amiinah, Voigt Robert, Johnson Shirley
Department of Community Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55944, USA.
Prim Care Respir J. 2011 Mar;20(1):79-83. doi: 10.4104/pcrj.2010.00076.
To characterise the relationship between ICD code-based (i.e. physician diagnosis-based) and criteria-based asthma ascertainment.
We compared identification of children with asthma between criteria-based medical record review for asthma ascertainment and an ICD-9 code-based approach. We determined the agreement rate and validity index of ICD code-based asthma ascertainment using asthma status by medical record review as a gold standard.
Of the 115 study subjects, the agreement between medical record review and ICD-9 coding was 81.6% with a kappa value of 0.28 (P<0.0001). Sensitivity, specificity, positive and negative predictive values for ICD-9 code were 24.0%, 97.8%, 75.0%, and 82.0%, respectively, using criteria for asthma by medical record review as gold standard.
ICD code-based asthma ascertainment appears to under-identify children with asthma compared to criteria-based medical record review. ICD codes may be useful for etiologic research but may not be suitable for surveillance of asthma epidemiology.
描述基于国际疾病分类代码（即基于医生诊断）的哮喘确诊与基于标准的哮喘确诊之间的关系。
我们比较了基于标准的病历审查确诊哮喘儿童与基于国际疾病分类第九版（ICD-9）代码的方法在哮喘确诊方面的情况。我们以病历审查确定的哮喘状态作为金标准，确定基于ICD代码的哮喘确诊的一致率和效度指数。
在115名研究对象中，病历审查与ICD-9编码之间的一致性为81.6%，kappa值为0.28（P<0.0001）。以病历审查的哮喘标准作为金标准，ICD-9代码的敏感性、特异性、阳性预测值和阴性预测值分别为24.0%、97.8%、75.0%和82.0%。
与基于标准的病历审查相比，基于ICD代码的哮喘确诊似乎会漏诊哮喘儿童。ICD代码可能对病因学研究有用，但可能不适用于哮喘流行病学监测。
