Department of Community Health, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Infect Control Hosp Epidemiol. 2012 Jun;33(6):581-8. doi: 10.1086/665722. Epub 2012 Apr 12.
Blood and body fluid exposures are frequently evaluated in emergency departments (EDs). However, efficient and effective methods for estimating their incidence are not yet established.
Evaluate the efficiency and accuracy of estimating statewide ED visits for blood or body fluid exposures using International Classification of Diseases, Ninth Revision (ICD-9), code searches.
Secondary analysis of a database of ED visits for blood or body fluid exposure.
EDs of 11 civilian hospitals throughout Rhode Island from January 1, 1995, through June 30, 2001.
Patients presenting to the ED for possible blood or body fluid exposure were included, as determined by prespecified ICD-9 codes.
Positive predictive values (PPVs) were estimated to determine the ability of 10 ICD-9 codes to distinguish ED visits for blood or body fluid exposure from ED visits that were not for blood or body fluid exposure. Recursive partitioning was used to identify an optimal subset of ICD-9 codes for this purpose. Random-effects logistic regression modeling was used to examine variations in ICD-9 coding practices and styles across hospitals. Cluster analysis was used to assess whether the choice of ICD-9 codes was similar across hospitals.
The PPV for the original 10 ICD-9 codes was 74.4% (95% confidence interval [CI], 73.2%-75.7%), whereas the recursive partitioning analysis identified a subset of 5 ICD-9 codes with a PPV of 89.9% (95% CI, 88.9%-90.8%) and a misclassification rate of 10.1%. The ability, efficiency, and use of the ICD-9 codes to distinguish types of ED visits varied across hospitals.
Although an accurate subset of ICD-9 codes could be identified, variations across hospitals related to hospital coding style, efficiency, and accuracy greatly affected estimates of the number of ED visits for blood or body fluid exposure.
血液和体液暴露在急诊部门（ED）中经常进行评估。然而，尚未建立用于估计其发病率的高效和有效的方法。
使用国际疾病分类，第九修订版（ICD-9）代码搜索评估全州 ED 就诊血液或体液暴露的效率和准确性。
对 ED 就诊血液或体液暴露的数据库进行二次分析。
1995 年 1 月 1 日至 2001 年 6 月 30 日期间，罗德岛 11 家民用医院的 ED。
根据预定的 ICD-9 代码确定，包括因可能的血液或体液暴露而到 ED 就诊的患者。
估计阳性预测值（PPV），以确定 10 个 ICD-9 代码区分 ED 就诊血液或体液暴露与非血液或体液暴露的 ED 就诊的能力。递归分区用于为此目的确定 ICD-9 代码的最佳子集。使用随机效应逻辑回归模型检查医院之间 ICD-9 编码实践和风格的变化。聚类分析用于评估医院之间 ICD-9 代码选择是否相似。
原始 10 个 ICD-9 代码的 PPV 为 74.4%（95%置信区间[CI]，73.2%-75.7%），而递归分区分析确定了一个由 5 个 ICD-9 代码组成的子集，PPV 为 89.9%（95%CI，88.9%-90.8%）和 10.1%的错误分类率。区分 ED 就诊类型的 ICD-9 代码的能力、效率和使用在医院之间存在差异。
尽管可以确定准确的 ICD-9 代码子集，但医院编码风格、效率和准确性方面的差异极大地影响了血液或体液暴露的 ED 就诊人数的估计。
