国际疾病分类（ICD-9）代码是否能准确识别临床上患有缺氧缺血性脑病的新生儿？

Does the International Classification of Disease (ICD-9) code accurately identify neonates who clinically have hypoxic-ischemic encephalopathy?

机构信息

Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Miss., USA.

出版信息

Gynecol Obstet Invest. 2011;71(3):202-6. doi: 10.1159/000318204. Epub 2010 Dec 15.

Abstract

BACKGROUND/AIMS: Hypoxic-ischemic encephalopathy (HIE) refers to neonatal neurological signs and symptoms of hypoxia and/or ischemia. Our aim was to determine the accuracy of ICD-9 codes to identify newborns with HIE confirmed by umbilical cord blood analysis.

METHODS

ICD-9 codes in the newborn chart for birth trauma, birth asphyxia, intrauterine hypoxia, and fetal distress were used to identify newborns with suspected HIE by neonatal personnel. Maternal charts were reviewed for umbilical cord gases meeting the HIE clinical criteria.

RESULTS

There were 21,008 deliveries at center I and 17,540 at center II. ICD-9 codes identified 172 neonates, 49 infants (2.3‰ births) at center I and 123 neonates (7‰) at center II. Only 3 neonates (6%) were ≥34 weeks and none met ACOG criteria [umbilical artery pH <7.00 or base excess (BE) ≥12 mmol/l at center I]. At center II, 80 infants were ≥34 weeks but only 5/123 (4%) met the ACOG clinical criteria for HIE (pH <7.00, BE ≥12 mmol/l, and Apgar ≤3 at 5 min).

CONCLUSIONS

ICD-9 codes are unreliable in identifying birth asphyxia and cannot identify newborns meeting the clinical criteria for intrapartum HIE.

摘要

背景/目的：缺氧缺血性脑病（HIE）是指新生儿由于缺氧和/或缺血而出现的神经系统体征和症状。我们的目的是确定 ICD-9 编码在识别通过脐带血分析确诊的 HIE 新生儿的准确性。

方法

新生儿病历中的 ICD-9 编码用于出生创伤、出生窒息、宫内缺氧和胎儿窘迫，由新生儿人员识别疑似 HIE 的新生儿。对符合 HIE 临床标准的脐带血气进行了母亲图表的回顾。

结果

中心 I 有 21008 例分娩，中心 II 有 17540 例分娩。ICD-9 编码确定了 172 例新生儿，中心 I 有 49 例婴儿（2.3‰分娩），中心 II 有 123 例新生儿（7‰）。只有 3 例新生儿（6%）≥34 周，且均不符合 ACOG 标准[中心 I 的脐动脉 pH<7.00 或碱剩余（BE）≥12mmol/l]。在中心 II，80 例婴儿≥34 周，但只有 5/123（4%）符合 ACOG 产前 HIE 的临床标准（pH<7.00、BE≥12mmol/l 和 Apgar 在 5 分钟时≤3）。