Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Clin Gastroenterol Hepatol. 2012 Jul;10(7):805-811.e1. doi: 10.1016/j.cgh.2012.03.025. Epub 2012 Apr 10.
BACKGROUND & AIMS: Although widely used, little information exists on the validity of using hospital administrative data to code acute pancreatitis (AP). We sought to determine if discharge diagnosis codes accurately identify patients whose clinical course met the standard for AP diagnosis.
We analyzed data from 401 unique patients admitted through the emergency department who received a primary inpatient discharge diagnosis of AP at 2 University of Pittsburgh Medical Center hospitals in the years 2000, 2002, and 2005. Each patient was matched with a control patient who was admitted with abdominal pain and then discharged without a diagnosis of AP. Patients were matched based on demographics, testing for serum levels of pancreatic enzymes, year of visit to the emergency department, admission to the intensive care unit, and performance of abdominal computed tomography scan. The standard used to diagnose AP was the presence of 2 of 3 features (abdominal pain, ≥ 3-fold increase in serum levels of pancreatic enzymes, and positive results from imaging analysis).
The median age of AP cases was 53 years (interquartile range, 41.5-67 years); 47.1% were male, 85% were white. The most common etiologies were biliary (33.4%), alcohol-associated (16.2%), and idiopathic (24.2%). Serum levels of pancreatic enzymes were increased by any amount, and by ≥ 3-fold, in 95.3% and 68.6% of patients diagnosed with AP and in 16.2% and 2.2% of controls, respectively. The standard for diagnosis of AP was met in 80% of cases diagnosed with this disorder; they had no history of pancreatitis. The sensitivity, specificity, and positive and negative predictive values of the AP diagnosis code were 96%, 85%, 80%, and 98%, respectively.
Approximately 1 of 5 patients diagnosed with AP upon discharge from the hospital do not meet the guidelines for diagnosis of this disorder. Efforts should be made to more consistently use guidelines for AP diagnosis.
尽管医院管理数据被广泛用于编码急性胰腺炎（AP），但关于其有效性的信息却很少。我们试图确定出院诊断代码是否能准确识别符合 AP 诊断标准的患者。
我们分析了 2000 年、2002 年和 2005 年在匹兹堡大学医学中心的 2 家医院通过急诊科入院的 401 名具有独特特征的患者的数据，这些患者的主要住院诊断为 AP。每个患者都与一名对照患者相匹配，该对照患者因腹痛入院，但出院时没有 AP 诊断。患者根据人口统计学特征、血清胰腺酶水平检测、急诊科就诊年份、入住重症监护病房和进行腹部计算机断层扫描进行匹配。诊断 AP 的标准是存在 3 个特征中的 2 个（腹痛、血清胰腺酶水平升高≥3 倍和影像学分析阳性结果）。
AP 病例的中位年龄为 53 岁（四分位距，41.5-67 岁）；47.1%为男性，85%为白人。最常见的病因是胆源性（33.4%）、酒精相关性（16.2%）和特发性（24.2%）。诊断为 AP 的患者中，血清胰腺酶水平升高任意程度和升高≥3 倍的比例分别为 95.3%和 68.6%，而对照组中分别为 16.2%和 2.2%。符合 AP 诊断标准的病例中，80%的患者以前没有胰腺炎病史。AP 诊断代码的灵敏度、特异性、阳性预测值和阴性预测值分别为 96%、85%、80%和 98%。
大约每 5 名出院时诊断为 AP 的患者中，就有 1 名不符合该疾病诊断标准。应努力更一致地使用 AP 诊断指南。
