Dasenbrock Hormuzdiyar H, Cote David J, Pompeu Yuri, Vasudeva Viren S, Smith Timothy R, Gormley William B
Cushing Neurological Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
BMC Neurol. 2017 Jun 26;17(1):121. doi: 10.1186/s12883-017-0864-8.
Although International Classification of Disease, Ninth Revision, Clinical Modification (ICD9-CM) coding is the basis of administrative claims data, no study has validated an ICD9-CM algorithm to identify patients undergoing decompressive craniectomy for space-occupying supratentorial infarction.
Patients who underwent decompressive craniectomy for stroke at our institution were retrospectively identified and their associated ICD9-CM codes were extracted from billing data. An ICD9-CM algorithm was generated and its accuracy compared against physician review.
A total of 10,925 neurosurgical operations were performed from December 2008 to March 2015, of which 46 (0.4%) were decompressive craniectomy for space-occupying stroke. The ICD9-CM procedure code for craniectomy (01.25) was only encoded in 67.4% of patients, while craniotomy (01.24) was used in 19.6% and lobectomy (01.39, 01.53, 01.59) in 13.1%. The ICD-9-CM algorithm included patients with a diagnosis codes for cerebral infarction (433.11, 434.01, 434.11, and 434.91) and a procedure code for craniotomy, craniectomy, or lobectomy. Patients were excluded with an ICD9-CM diagnosis code for brain tumor, intracranial abscess, subarachnoid hemorrhage, vertebrobasilar infarction, intracranial aneurysm, Moyamoya disease, intracranial venous sinus thrombosis, vertebral artery dissection, congenital cerebrovascular anomaly, head trauma or an ICD9-CM procedure code for laminectomy. This algorithm had a sensitivity of 97.8%, specificity of 99.9%, positive predictive value of 88.2%, and negative predictive value of 99.9%. The majority of false-positive results were patients who underwent evacuation of a primary intracerebral hematoma.
An ICD-9-CM algorithm based on diagnosis and procedure codes can effectively identify patients undergoing decompressive craniectomy for supratentorial stroke.
尽管国际疾病分类第九版临床修订本（ICD9-CM）编码是行政索赔数据的基础，但尚无研究验证用于识别因幕上占位性梗死接受减压性颅骨切除术患者的ICD9-CM算法。
回顾性确定在我们机构接受中风减压性颅骨切除术的患者，并从计费数据中提取其相关的ICD9-CM编码。生成ICD9-CM算法，并将其准确性与医生的审查结果进行比较。
2008年12月至2015年3月共进行了10925例神经外科手术，其中46例（0.4%）为因占位性中风进行的减压性颅骨切除术。颅骨切除术的ICD9-CM手术编码（01.25）仅在67.4%的患者中编码，而开颅手术（01.24）的编码率为19.6%，肺叶切除术（01.39、01.53、01.59）的编码率为13.1%。ICD-9-CM算法纳入了具有脑梗死诊断编码（433.11、434.01、434.11和434.91）以及开颅手术、颅骨切除术或肺叶切除术手术编码的患者。具有脑肿瘤、颅内脓肿、蛛网膜下腔出血、椎基底动脉梗死、颅内动脉瘤、烟雾病、颅内静脉窦血栓形成、椎动脉夹层、先天性脑血管异常、头部外伤的ICD9-CM诊断编码或椎板切除术的ICD9-CM手术编码的患者被排除。该算法的敏感性为97.8%，特异性为99.9%，阳性预测值为88.2%，阴性预测值为99.9%。大多数假阳性结果是接受原发性脑内血肿清除术的患者。
基于诊断和手术编码的ICD-9-CM算法可有效识别因幕上中风接受减压性颅骨切除术的患者。
