Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
J Am Med Inform Assoc. 2014 May-Jun;21(3):547-57. doi: 10.1136/amiajnl-2013-002116. Epub 2013 Nov 12.
Adverse drug events, the unintended and harmful effects of medications, are important outcome measures in health services research. Yet no universally accepted set of International Classification of Diseases (ICD) revision 10 codes or coding algorithms exists to ensure their consistent identification in administrative data. Our objective was to synthesize a comprehensive set of ICD-10 codes used to identify adverse drug events.
We developed a systematic search strategy and applied it to five electronic reference databases. We searched relevant medical journals, conference proceedings, electronic grey literature and bibliographies of relevant studies, and contacted content experts for unpublished studies. One author reviewed the titles and abstracts for inclusion and exclusion criteria. Two authors reviewed eligible full-text articles and abstracted data in duplicate. Data were synthesized in a qualitative manner.
Of 4241 titles identified, 41 were included. We found a total of 827 ICD-10 codes that have been used in the medical literature to identify adverse drug events. The median number of codes used to search for adverse drug events was 190 (IQR 156-289) with a large degree of variability between studies in the numbers and types of codes used. Authors commonly used external injury (Y40.0-59.9) and disease manifestation codes. Only two papers reported on the sensitivity of their code set.
Substantial variability exists in the methods used to identify adverse drug events in administrative data. Our work may serve as a point of reference for future research and consensus building in this area.
药物不良反应是药物的意外和有害影响，是卫生服务研究中的重要结果衡量指标。然而，在管理数据中确保其一致识别，并没有一套通用的国际疾病分类（ICD）第 10 版代码或编码算法。我们的目标是综合一套用于识别药物不良反应的 ICD-10 代码。
我们制定了系统的搜索策略并将其应用于五个电子参考数据库。我们检索了相关医学期刊、会议录、电子灰色文献以及相关研究的参考文献，并联系了内容专家以获取未发表的研究。一位作者对标题和摘要进行了纳入和排除标准的审查。两位作者对符合条件的全文文章进行了审查，并进行了重复的数据摘录。数据以定性方式进行综合。
在确定的 4241 个标题中，有 41 个符合条件。我们在医学文献中发现了总共 827 个 ICD-10 代码，这些代码用于识别药物不良反应。用于搜索药物不良反应的代码中位数数量为 190（IQR 156-289），但研究之间使用的代码数量和类型存在很大差异。作者通常使用外部损伤（Y40.0-59.9）和疾病表现代码。只有两篇论文报告了其代码集的敏感性。
在管理数据中识别药物不良反应的方法存在很大差异。我们的工作可以为该领域的未来研究和共识建立提供参考。
