Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
J Am Med Inform Assoc. 2013 May 1;20(3):441-5. doi: 10.1136/amiajnl-2012-001558. Epub 2013 Mar 5.
With increasing use electronic health records (EHR) in the USA, we looked at the predictive values of the International Classification of Diseases, 9th revision (ICD-9) coding system for surveillance of chronic hepatitis B virus (HBV) infection.
The chronic HBV cohort from the Chronic Hepatitis Cohort Study was created based on electronic health records (EHR) of adult patients who accessed services from 2006 to 2008 from four healthcare systems in the USA. Using the gold standard of abstractor review to confirm HBV cases, we calculated the sensitivity, specificity, positive and negative predictive values using one qualifying ICD-9 code versus using two qualifying ICD-9 codes separated by 6 months or greater.
Of 1 652 055 adult patients, 2202 (0.1%) were confirmed as having chronic HBV. Use of one ICD-9 code had a sensitivity of 83.9%, positive predictive value of 61.0%, and specificity and negative predictive values greater than 99%. Use of two hepatitis B-specific ICD-9 codes resulted in a sensitivity of 58.4% and a positive predictive value of 89.9%.
Use of one or two hepatitis B ICD-9 codes can identify cases with chronic HBV infection with varying sensitivity and positive predictive values.
As the USA increases the use of EHR, surveillance using ICD-9 codes may be reliable to determine the burden of chronic HBV infection and would be useful to improve reporting by state and local health departments.
随着电子健康记录（EHR）在美国的使用越来越多，我们研究了国际疾病分类第 9 版（ICD-9）编码系统对慢性乙型肝炎病毒（HBV）感染监测的预测值。
慢性乙型肝炎病毒队列来自慢性丙型肝炎队列研究，该队列基于 2006 年至 2008 年期间来自美国四个医疗保健系统的成年患者的电子健康记录（EHR）创建。使用摘要审查的金标准来确认 HBV 病例，我们使用一个合格的 ICD-9 代码和使用两个合格的 ICD-9 代码（相隔 6 个月或更长时间）分别计算了敏感性、特异性、阳性和阴性预测值。
在 1 652 055 名成年患者中，有 2202 例（0.1%）被确认为患有慢性 HBV。使用一个 ICD-9 代码的敏感性为 83.9%，阳性预测值为 61.0%，特异性和阴性预测值均大于 99%。使用两个乙型肝炎特异性 ICD-9 代码的敏感性为 58.4%，阳性预测值为 89.9%。
使用一个或两个乙型肝炎 ICD-9 代码可以识别出具有不同敏感性和阳性预测值的慢性 HBV 感染病例。
随着美国增加 EHR 的使用，使用 ICD-9 代码进行监测可能可以可靠地确定慢性 HBV 感染的负担，并且对改善州和地方卫生部门的报告将非常有用。
