基于人群的研究：电子数据库中结节病诊断编码的准确性。
Accuracy of Diagnostic Coding for Sarcoidosis in Electronic Databases: A Population-Based Study.
机构信息
Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, 200 First Avenue SW, Rochester, MN, 55905, USA.
Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
出版信息
Lung. 2017 Dec;195(6):713-715. doi: 10.1007/s00408-017-0054-x. Epub 2017 Oct 9.
PURPOSE
Epidemiologic study of sarcoidosis utilizing electronic databases has been increasingly popular. However, the accuracy of diagnostic codes for sarcoidosis is unknown.
METHODS
The medical record-linkage system of the Rochester Epidemiology Project was searched to identify all potential adult cases of sarcoidosis between January 1, 1995 and December 31, 2013 in Olmsted County, Minnesota, using the International Classification of Diseases, Ninth Revision (ICD-9) code 135 (sarcoidosis). Complete medical records of those potential cases were individually reviewed. The diagnosis of sarcoidosis was confirmed by the presence of non-caseating granuloma on histopathology, radiographic findings of intrathoracic sarcoidosis, and compatible clinical presentations. Positive predictive value (PPV) was estimated as the number of patients verified to have sarcoidosis divided by the number of patients with a diagnostic code for sarcoidosis.
RESULTS
The study cohort included 366 patients with at least one code for sarcoidosis. Of these, 224 cases of confirmed sarcoidosis were identified, resulting in PPV of 61.2% (95% CI 56.0-66.2%). A total of 268 patients in the database had a code for sarcoidosis on least two occasions separated by at least 30 days. Of these, there were 205 cases of confirmed sarcoidosis. The PPV for having the code at least twice was 76.5% (95% CI 71.0-81.4%).
CONCLUSIONS
The PPV of ICD-9 code for sarcoidosis is relatively low and, thus, further verification is required for studies using electronic databases.
目的
利用电子数据库进行结节病的流行病学研究越来越受到欢迎。然而，结节病的诊断代码的准确性尚不清楚。
方法
罗切斯特流行病学项目的病历链接系统被用来在明尼苏达州奥姆斯特德县识别所有潜在的成年结节病病例，时间范围为 1995 年 1 月 1 日至 2013 年 12 月 31 日，使用国际疾病分类，第九版（ICD-9）代码 135（结节病）。对这些潜在病例的完整病历进行了单独审查。结节病的诊断通过组织病理学上无干酪样坏死的肉芽肿、胸部结节病的放射学表现和相容的临床表现来确认。阳性预测值（PPV）定义为经证实患有结节病的患者数量除以患有结节病诊断代码的患者数量。
结果
研究队列包括至少有一个结节病代码的 366 名患者。其中，224 例经证实的结节病患者被识别，PPV 为 61.2%（95%CI 56.0-66.2%）。数据库中共有 268 名患者至少有两次间隔至少 30 天的结节病代码。其中有 205 例经证实的结节病患者。至少有两次代码的 PPV 为 76.5%（95%CI 71.0-81.4%）。
结论
ICD-9 结节病代码的 PPV 相对较低，因此，对于使用电子数据库的研究需要进一步验证。
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