Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy.
Pharmacoepidemiol Drug Saf. 2013 Nov;22(11):1195-204. doi: 10.1002/pds.3504. Epub 2013 Aug 20.
To validate the International Classification of Diseases, 9th Revision, Clinical Modification discharge codes used to identify cases of upper gastrointestinal complications (UGICs) in hospitals of Friuli Venezia Giulia, Italy.
Cohort study on the risk of UGIC in users of nonsteroidal anti-inflammatory drugs conducted in Friuli Venezia Giulia between 2001 and 2008. Cases were identified through primary and secondary International Classification of Diseases, 9th Revision Clinical specific codes 531 (gastric ulcer), 532 (duodenal ulcer), 533 (peptic ulcer), 534 (gastrojejunal ulcer), and nonspecific code 578 (gastrointestinal hemorrhage). Potential cases were confirmed through hospital chart review.
The chart retrieval percentage was 98.4%.The positive predictive value (PPV) was 94.3% for primary codes 531 and 532, 79.5% for code 533, 83.1% for code 534, 40.2% for code 578. The PPV for secondary codes was 34.7% but increased to 88.9% and 79.2% when the primary code was for peritonitis or acute post-hemorrhagic anemia, respectively. Validation of secondary codes increased case ascertainment by 4.9%. Endoscopy confirmed 79.4% of cases but only 67.2% of those above age 84 years.
The PPV was high for specific primary codes and moderate to low for nonspecific primary and secondary codes. The inclusion of confirmed cases identified by nonspecific and secondary codes can be of value in studies that need a complete ascertainment of cases occurring in the study population. In this cohort, not including these cases would underestimate the incidence of UGICs. A potential for case misclassification exists in particular in eldest ages.
验证意大利弗留利-威尼斯朱利亚（Friuli Venezia Giulia）医院用于识别上消化道并发症（UGIC）病例的国际疾病分类第 9 版临床修正版出院代码。
这是一项在 2001 年至 2008 年期间在弗留利-威尼斯朱利亚进行的非甾体抗炎药使用者发生 UGIC 风险的队列研究。病例通过初级和二级国际疾病分类第 9 版临床特定代码 531（胃溃疡）、532（十二指肠溃疡）、533（消化性溃疡）、534（胃空肠溃疡）和非特异性代码 578（胃肠道出血）进行识别。通过医院病历回顾确认潜在病例。
病历检索率为 98.4%。初级代码 531 和 532 的阳性预测值（PPV）为 94.3%，代码 533 为 79.5%，代码 534 为 83.1%，代码 578 为 40.2%。二级代码的 PPV 为 34.7%，但当初级代码为腹膜炎或急性出血后贫血时，PPV 分别增加至 88.9%和 79.2%。二级代码的验证使病例确定增加了 4.9%。内镜检查证实了 79.4%的病例，但 84 岁以上的病例仅为 67.2%。
特异性初级代码的 PPV 较高，而非特异性初级和二级代码的 PPV 为中等至较低。包括通过非特异性和二级代码确认的病例可以为需要对研究人群中发生的病例进行完整确定的研究提供价值。在本队列中，不包括这些病例会低估 UGIC 的发生率。在最年长的年龄组中存在病例误诊的可能性。
