Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA.
Ann Epidemiol. 2013 Mar;23(3):136-42. doi: 10.1016/j.annepidem.2012.12.009. Epub 2013 Jan 10.
To evaluate the value of ICD-9-CM code for identifying celiac disease (CD).
We searched administrative data to identify all adults with ICD-9-CM diagnosis code 579.0 (CD) at three teaching hospitals between 2000 and 2010. We then stratified patients according to the presence/absence of relevant serology and endoscopy codes into four groups: None, serology, endoscopy, and both. A diagnostic algorithm was applied to define CD status.
Through random sampling and appropriate weighting, the 1200 reviewed patients represented a cohort of 8,122 cases. The overall positive predictive value (PPV) of the ICD-9-CM code was 15% (95% confidence interval [CI], 13%-17%). Case identification by a diagnosis code alone had a PPV of 4%, whereas the group with diagnosis code plus both serology and endoscopy testing had a PPV of 49%. Independent predictors of CD were non-Hispanic white, ICD-9-CM-coded patient group, total number of a diagnosis code, and receiving a diagnosis code by a gastroenterologist. The model had an area under the curve of 0.87 (95% CI, 0.84-0.89).
The performance of ICD-9-CM 579.0 alone for identifying CD is extremely poor. Adding other readily available administrative data significantly improves CD case identification. The proposed case finding strategy via administrative databases may facilitate future research on CD.
评估 ICD-9-CM 代码在识别乳糜泻（CD）中的价值。
我们在三家教学医院的 2000 年至 2010 年间，通过检索行政数据来识别所有 ICD-9-CM 诊断代码 579.0（CD）的成年患者。然后，我们根据是否存在相关的血清学和内镜代码，将患者分为四组：无、血清学、内镜和两者都有。应用诊断算法来定义 CD 状态。
通过随机抽样和适当加权，审查的 1200 名患者代表了 8122 例病例的队列。ICD-9-CM 代码的总体阳性预测值（PPV）为 15%（95%置信区间[CI]，13%-17%）。仅通过诊断代码识别病例的 PPV 为 4%，而同时具有诊断代码和血清学和内镜检查的组的 PPV 为 49%。CD 的独立预测因素是非西班牙裔白人、ICD-9-CM 编码患者组、诊断代码总数和由胃肠病学家进行诊断代码。该模型的曲线下面积为 0.87（95%CI，0.84-0.89）。
单独使用 ICD-9-CM 579.0 来识别 CD 的性能非常差。添加其他现成的行政数据可显著提高 CD 病例识别率。通过行政数据库提出的病例发现策略可能有助于未来对 CD 的研究。
