University of Colorado School of Medicine, Department of Emergency Medicine. Aurora, CO, United States.
Northwestern University, Department of Emergency Medicine, United States.
Resuscitation. 2018 Apr;125:8-11. doi: 10.1016/j.resuscitation.2018.01.021. Epub 2018 Jan 16.
International classification of disease (ICD-9) code 427.5 (cardiac arrest) is utilized to identify cohorts of patients who suffer out-of-hospital cardiac arrest (OHCA), though the use of ICD codes for this purpose has never been formally validated. We sought to validate the utility of ICD-9 code 427.5 by identifying patients admitted from the emergency department (ED) after OHCA.
Adult visits to a single ED between January 2007 and July 2012 were retrospectively examined and a keyword search of the electronic medical record (EMR) was used to identify patients. Cardiac arrest was confirmed; and ICD-9 information and location of return of spontaneous circulation (ROSC) were collected. Separately, the EMR was searched for patients who received ICD-9 code 427.5. The kappa coefficient (κ) was calculated, as was the sensitivity and specificity of the code for identifying OHCA.
The keyword search identified 1717 patients, of which 385 suffered OHCA and 333 were assigned the code 427.5. The agreement between ICD-9 code and cardiac arrest was excellent (κ = 0.895). The ICD-9 code 427.5 was both specific (99.4%) and sensitive (86.5%). Of the 52 cardiac arrests that were not identified by ICD-9 code, 33% had ROSC before arrival to the ED. When searching independently on ICD-9 code, 347 patients with ICD-9 code 427.5 were found, of which 320 were "true" arrests. This yielded a positive predictive value of 92% for ICD-9 code 427.5 in predicting OHCA.
ICD-9 code 427.5 is sensitive and specific for identifying ED patients who suffer OHCA with a positive predictive value of 92%.
国际疾病分类（ICD-9）代码 427.5（心搏骤停）用于识别患有院外心搏骤停（OHCA）的患者队列，尽管从未对 ICD 代码的这种用途进行过正式验证。我们试图通过识别从 OHCA 后从急诊部（ED）入院的患者来验证 ICD-9 代码 427.5 的实用性。
回顾性检查了 2007 年 1 月至 2012 年 7 月期间在单个 ED 的成年患者就诊情况，并对电子病历（EMR）进行了关键字搜索，以识别患者。确认心搏骤停；并收集 ICD-9 信息和自主循环恢复（ROSC）的位置。另外，还在 EMR 中搜索了接受 ICD-9 代码 427.5 的患者。计算了 Kappa 系数（κ），以及该代码识别 OHCA 的灵敏度和特异性。
关键字搜索确定了 1717 名患者，其中 385 名患有 OHCA，333 名患者被分配了 427.5 代码。ICD-9 代码与心搏骤停之间的一致性非常好（κ=0.895）。ICD-9 代码 427.5 特异性高（99.4%）且敏感性高（86.5%）。在未通过 ICD-9 代码识别的 52 次心搏骤停中，有 33%在到达 ED 之前有 ROSC。当独立搜索 ICD-9 代码时，发现了 347 名 ICD-9 代码为 427.5 的患者，其中 320 名是“真正的”心搏骤停。这使得 ICD-9 代码 427.5 预测 OHCA 的阳性预测值为 92%。
ICD-9 代码 427.5 可用于识别患有 OHCA 的 ED 患者，具有 92%的阳性预测值，其灵敏度和特异性均较高。
