Hsu D Y, Dalal P, Sable K A, Voruganti N, Nardone B, West D P, Silverberg J I
Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Allergy. 2017 Jul;72(7):1091-1095. doi: 10.1111/all.13113. Epub 2017 Jan 17.
Evaluation of large-scale data sets is needed to better understand the epidemiology, cost, and burden of atopic dermatitis (AD). We sought to validate the use of ICD-9-CM codes for identifying AD.
Patients from a large metropolitan quaternary care medical center with a diagnostic code of either 691.8 (AD) or 692.9 (eczema and contact dermatitis) were queried. Medical records were reviewed for demographics, Hanifin & Rajka (H&R) and United Kingdom Working Party (UKWP) criteria. Sensitivity, specificity, and positive predictive values (PPV) of the codes were calculated.
Of 43 278 patients identified with associated ICD-9 codes of 691.8 or 692.9, 519 and 253 with 691.8 and 692.9 were randomly selected for chart review. There was extensive overlap: 34.3% had ≥1 occurrences of 691.8 and 692.9 and 25.6% had multiple occurrences of both codes. Among patients with ≥1 occurrence of 691.8, 29.9% and 30.8% met the H&R and UKWP criteria, respectively. Similarly, among patients with ≥1 occurrence of 692.9, 33.7% and 32.2% met the H&R and UKWP criteria. Increased PPV was associated with concomitant diagnoses of asthma, hay fever, and food allergy and increased disease severity.
In the outpatient setting, the ICD-9-CM codes 691.8 and 692.9 alone have poor PPV. Incorporation of diagnoses of asthma, hay fever, and food allergy improves PPV and specificity. In the inpatient setting, a primary discharge diagnosis of 691.8 had excellent PPV. Although ICD-10 has been adopted in Europe and more recently in the USA, the same systematic errors would likely occur unless providers standardize their coding.
需要对大规模数据集进行评估，以更好地了解特应性皮炎（AD）的流行病学、成本和负担。我们试图验证使用国际疾病分类第九版临床修订本（ICD - 9 - CM）编码来识别AD的情况。
查询来自一个大型大都市四级医疗中心、诊断编码为691.8（AD）或692.9（湿疹和接触性皮炎）的患者。查阅病历以获取人口统计学信息、哈尼芬和拉伊卡（H&R）标准以及英国工作组（UKWP）标准。计算编码的敏感性、特异性和阳性预测值（PPV）。
在43278名被识别出具有691.8或692.9相关ICD - 9编码的患者中，随机选择了519名编码为691.8的患者和253名编码为692.9的患者进行病历审查。存在广泛重叠：34.3%的患者有≥1次691.8和692.9的编码，25.6%的患者两种编码都有多次出现。在有≥1次691.8编码的患者中，分别有29.9%和30.8%符合H&R和UKWP标准。同样，在有≥1次692.9编码的患者中，分别有33.7%和32.2%符合H&R和UKWP标准。PPV的增加与哮喘、花粉症和食物过敏的伴随诊断以及疾病严重程度增加相关。
在门诊环境中，单独的ICD - 9 - CM编码691.8和692.9的PPV较差。纳入哮喘、花粉症和食物过敏的诊断可提高PPV和特异性。在住院环境中，主要出院诊断为691.8具有出色的PPV。尽管欧洲已采用国际疾病分类第十版（ICD - 10），美国最近也开始采用，但除非医疗服务提供者规范其编码，否则可能会出现同样的系统性错误。
