Department of Pharmacotherapy, University of Utah College of Pharmacy, 30 South 2000 East, Salt Lake City, UT 84112, United States.
Department of Pharmacotherapy, University of Utah College of Pharmacy, 30 South 2000 East, Salt Lake City, UT 84112, United States; Thrombosis Service, University of Utah Hospital, 50 North Medical Drive Room 1R211, Salt Lake City, UT 84132, United States.
Thromb Res. 2019 Sep;181:71-76. doi: 10.1016/j.thromres.2019.07.021. Epub 2019 Jul 24.
Administratively coded data are frequently used in observational research to identify outcome events. With the transition to the new International Classification of Diseases coding system's 10th version (ICD-10), information is needed about the coding accuracy for bleeding events in anticoagulated patients. We aimed to determine ICD-10 code accuracy for bleeding events in anticoagulated patients admitted to the hospital.
This cross-sectional study retrospectively examined charts of anticoagulated patients who were admitted to the University of Utah Hospital between October 1, 2017 and December 31, 2017. Two trained chart abstractors blinded to ICD-10 code status independently reviewed medical charts to determine the presence or absence of bleeding events. ICD-10 code status in any diagnosis position was unblinded and code accuracy was assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) along with 95% confidence intervals (CI).
Out of 661 admissions, 487 unique patients and 71 bleeding events were identified. Gastrointestinal tract bleeding and intracranial hemorrhage comprised 32.4% and 19.7% of bleeding events respectively. ICD-10 code sensitivity was 91.4% (95% CI, 82.3-96.8), specificity was 90.2% (87.5-92.5), PPV was 52.5% (43.2-61.6) and NPV 98.9% (97.6-99.6). Individual codes for intracranial hemorrhages and gastrointestinal tract bleeding had similar accuracy as the overall set of bleeding codes.
Our results demonstrate that ICD-10 codes can reliably rule-out hospitalizations for bleeding events in patients receiving anticoagulation therapy. Due to unacceptable false positive rates ICD-10 codes should not be used for identifying bleeding complications without confirmatory chart review.
在观察性研究中，常使用管理编码数据来确定结局事件。随着新的国际疾病分类第十版（ICD-10）的过渡，需要了解抗凝患者出血事件的编码准确性。我们旨在确定住院抗凝患者出血事件的 ICD-10 编码准确性。
这项横断面研究回顾性地检查了 2017 年 10 月 1 日至 12 月 31 日期间入住犹他大学医院的抗凝患者的病历。两名经过培训的病历摘录员在不了解 ICD-10 编码状态的情况下独立审查病历，以确定是否存在出血事件。任何诊断位置的 ICD-10 编码状态被揭示，并使用敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）以及 95%置信区间（CI）评估编码准确性。
在 661 次入院中，确定了 487 名独特患者和 71 例出血事件。胃肠道出血和颅内出血分别占出血事件的 32.4%和 19.7%。ICD-10 编码的敏感性为 91.4%（95%CI，82.3-96.8），特异性为 90.2%（87.5-92.5），PPV 为 52.5%（43.2-61.6），NPV 为 98.9%（97.6-99.6）。颅内出血和胃肠道出血的单个编码与总体出血编码具有相似的准确性。
我们的结果表明，ICD-10 编码可可靠排除接受抗凝治疗的患者因出血事件住院的情况。由于假阳性率不可接受，在没有确认性病历审查的情况下，ICD-10 编码不应用于识别出血并发症。
