验证 ICD-9-CM 代码在大型儿童医院中用于识别与对乙酰氨基酚相关的急诊就诊情况。

Validation of ICD-9-CM codes for identification of acetaminophen-related emergency department visits in a large pediatric hospital.

机构信息

Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd,, 77030, Houston, TX, USA.

出版信息

BMC Health Serv Res. 2013 Feb 21;13:72. doi: 10.1186/1472-6963-13-72.

DOI:10.1186/1472-6963-13-72

PMID:23433397

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3585943/

Abstract

BACKGROUND

Acetaminophen overdose is a major concern among the pediatric population. Our objective was to assess the validity of International Classification of Disease (ICD-9-CM) codes for identification of pediatric emergency department (ED) visits resulting from acetaminophen exposure or overdose.

METHODS

We conducted a retrospective medical record review of ED visits at Texas Children's Hospital in Houston, Texas, between January 1, 2005, and December 31, 2010. Visits coded with 1 or more ICD-9 codes for poisoning (965, 977, and their subcodes and supplemental E-codes E850, E858, E935, E947, and E950 and their subcodes) were identified from an administrative database, and further review of the medical records was conducted to identify true cases of acetaminophen exposure or overdose. We then examined the sensitivity, positive predictive value, and percentage of false positives identified by various codes and code combinations to establish which codes most accurately identified acetaminophen exposure or overdose.

RESULTS

Of 1,215 ED visits documented with 1 or more of the selected codes, 316 (26.0%) were a result of acetaminophen exposure or overdose. Sensitivity was highest (87.0%) for the combination of codes 965.4 (poisoning by aromatic analgesics, not elsewhere classified) and E950.0 (suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics), with a positive predictive value of 86.2%. Code 965.4 alone yielded a sensitivity of 85.1%, with a positive predictive value of 92.8%. Code performance varied among age groups and depending on the type of exposure (intentional or unintentional).

CONCLUSION

ICD-9 codes are useful for ascertaining which ED visits are a result of acetaminophen exposure or overdose within the pediatric population. However, because ICD-9 coding differs by age group and depending on the type of exposure, hypothesis-driven strategies must be utilized for each pediatric age group to avoid misclassification.

摘要

背景

对乙酰氨基酚过量是儿科人群的主要关注点。我们的目的是评估国际疾病分类（ICD-9-CM）代码是否可用于识别因接触或过量使用对乙酰氨基酚而导致的儿科急诊就诊。

方法

我们对 2005 年 1 月 1 日至 2010 年 12 月 31 日期间在德克萨斯州休斯顿的德克萨斯儿童医疗中心就诊的急诊科就诊记录进行了回顾性病历审查。从一个管理数据库中确定了编码为 1 个或多个中毒 ICD-9 代码（965、977 及其亚码以及补充 E 代码 E850、E858、E935、E947 和 E950 及其亚码）的就诊，并对病历进行了进一步审查，以确定真实的对乙酰氨基酚接触或过量使用病例。然后，我们检查了各种代码和代码组合的灵敏度、阳性预测值和假阳性百分比，以确定哪些代码最准确地识别对乙酰氨基酚接触或过量使用。

结果

在所记录的 1215 次急诊科就诊中，有 316 次（26.0%）是对乙酰氨基酚接触或过量使用的结果。代码 965.4（未在其他地方分类的芳香族镇痛药中毒）和 E950.0（镇痛药、解热药和抗风湿药的自杀和自我中毒）组合的灵敏度最高（87.0%），阳性预测值为 86.2%。单独使用代码 965.4 的灵敏度为 85.1%，阳性预测值为 92.8%。代码性能因年龄组而异，并且取决于暴露类型（故意或非故意）。