Division of Nephrology, Department of Medicine, Western University, London, Canada.
BMJ Open. 2012 Dec 28;2(6). doi: 10.1136/bmjopen-2012-002011. Print 2012.
Evaluate the validity of the International Classification of Diseases, 10th revision (ICD-10) code for hyperkalaemia (E87.5) in two settings: at presentation to an emergency department and at hospital admission.
Population-based validation study.
12 hospitals in Southwestern Ontario, Canada, from 2003 to 2010.
Elderly patients with serum potassium values at presentation to an emergency department (n=64 579) and at hospital admission (n=64 497).
Sensitivity, specificity, positive-predictive value and negative-predictive value. Serum potassium values in patients with and without a hyperkalaemia code (code positive and code negative, respectively).
The sensitivity of the best-performing ICD-10 coding algorithm for hyperkalaemia (defined by serum potassium >5.5 mmol/l) was 14.1% (95% CI 12.5% to 15.9%) at presentation to an emergency department and 14.6% (95% CI 13.3% to 16.1%) at hospital admission. Both specificities were greater than 99%. In the two settings, the positive-predictive values were 83.2% (95% CI 78.4% to 87.1%) and 62.0% (95% CI 57.9% to 66.0%), while the negative-predictive values were 97.8% (95% CI 97.6% to 97.9%) and 96.9% (95% CI 96.8% to 97.1%). In patients who were code positive for hyperkalaemia, median (IQR) serum potassium values were 6.1 (5.7 to 6.8) mmol/l at presentation to an emergency department and 6.0 (5.1 to 6.7) mmol/l at hospital admission. For code-negative patients median (IQR) serum potassium values were 4.0 (3.7 to 4.4) mmol/l and 4.1 (3.8 to 4.5) mmol/l in each of the two settings, respectively.
Patients with hospital encounters who were ICD-10 E87.5 hyperkalaemia code positive and negative had distinct higher and lower serum potassium values, respectively. However, due to very low sensitivity, the incidence of hyperkalaemia is underestimated.
在两个环境中评估国际疾病分类第 10 版（ICD-10）高钾血症（E87.5）代码的有效性：急诊就诊时和入院时。
基于人群的验证研究。
加拿大安大略省西南部的 12 家医院，时间为 2003 年至 2010 年。
急诊就诊时血清钾值的老年患者（n=64579）和入院时（n=64497）。
灵敏度、特异性、阳性预测值和阴性预测值。有和没有高钾血症代码的患者（代码阳性和代码阴性，分别）的血清钾值。
在急诊就诊时（定义为血清钾>5.5 mmol/L）和入院时（血清钾>5.5 mmol/L），表现最佳的 ICD-10 编码算法的高钾血症的灵敏度分别为 14.1%（95%CI 12.5%至 15.9%）和 14.6%（95%CI 13.3%至 16.1%）。两个环境中的特异性均大于 99%。在这两个环境中，阳性预测值分别为 83.2%（95%CI 78.4%至 87.1%）和 62.0%（95%CI 57.9%至 66.0%），而阴性预测值分别为 97.8%（95%CI 97.6%至 97.9%）和 96.9%（95%CI 96.8%至 97.1%）。在高钾血症代码阳性的患者中，急诊就诊时血清钾中位数（IQR）为 6.1（5.7 至 6.8）mmol/L，入院时为 6.0（5.1 至 6.7）mmol/L。在代码阴性的患者中，在每个环境中，中位数（IQR）血清钾值分别为 4.0（3.7 至 4.4）mmol/L 和 4.1（3.8 至 4.5）mmol/L。
ICD-10 E87.5 高钾血症代码阳性和阴性的住院患者的血清钾值分别明显更高和更低。然而，由于敏感性非常低，高钾血症的发生率被低估了。
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