Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.
Data Science Services, University of Utah Health Sciences Center, Salt Lake City.
JAMA Netw Open. 2020 Aug 3;3(8):e2017703. doi: 10.1001/jamanetworkopen.2020.17703.
International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes are used to characterize coronavirus disease 2019 (COVID-19)-related symptoms. Their accuracy is unknown, which could affect downstream analyses.
To compare the performance of fever-, cough-, and dyspnea-specific ICD-10 codes with medical record review among patients tested for COVID-19.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included patients who underwent quantitative reverse transcriptase-polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 at University of Utah Health from March 10 to April 6, 2020. Data analysis was performed in April 2020.
The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ICD-10 codes for fever (R50*), cough (R05*), and dyspnea (R06.0*) were compared with manual medical record review. Performance was calculated overall and stratified by COVID-19 test result, sex, age group (<50, 50-64, and >64 years), and inpatient status. Bootstrapping was used to generate 95% CIs, and Pearson χ2 tests were used to compare different subgroups.
Among 2201 patients tested for COVD-19, the mean (SD) age was 42 (17) years; 1201 (55%) were female, 1569 (71%) were White, and 282 (13%) were Hispanic or Latino. The prevalence of fever was 66% (1444 patients), that of cough was 88% (1930 patients), and that of dyspnea was 64% (1399 patients). For fever, the sensitivity of ICD-10 codes was 0.26 (95% CI, 0.24-0.29), specificity was 0.98 (95% CI, 0.96-0.99), PPV was 0.96 (95% CI, 0.93-0.97), and NPV was 0.41 (95% CI, 0.39-0.43). For cough, the sensitivity of ICD-10 codes was 0.44 (95% CI, 0.42-0.46), specificity was 0.88 (95% CI, 0.84-0.92), PPV was 0.96 (95% CI, 0.95-0.97), and NPV was 0.18 (95% CI, 0.16-0.20). For dyspnea, the sensitivity of ICD-10 codes was 0.24 (95% CI, 0.22-0.26), specificity was 0.97 (95% CI, 0.96-0.98), PPV was 0.93 (95% CI, 0.90-0.96), and NPV was 0.42 (95% CI, 0.40-0.44). ICD-10 code performance was better for inpatients than for outpatients for fever (χ2 = 41.30; P < .001) and dyspnea (χ2 = 14.25; P = .003) but not for cough (χ2 = 5.13; P = .16).
These findings suggest that ICD-10 codes lack sensitivity and have poor NPV for symptoms associated with COVID-19. This inaccuracy has implications for any downstream data model, scientific discovery, or surveillance that relies on these codes.
国际疾病分类第十版（ICD-10）代码用于描述 2019 年冠状病毒病（COVID-19）相关症状。其准确性尚不清楚，这可能会影响下游分析。
比较发热、咳嗽和呼吸困难特定 ICD-10 代码与 COVID-19 检测患者的病历审查结果。
设计、设置和参与者：这项队列研究纳入了 2020 年 3 月 10 日至 4 月 6 日在犹他大学健康中心接受严重急性呼吸综合征冠状病毒 2 定量逆转录-聚合酶链反应检测的患者。数据分析于 2020 年 4 月进行。
比较 ICD-10 代码（R50*、R05和 R06.0）对发热、咳嗽和呼吸困难的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），与手动病历审查结果进行比较。计算了 COVID-19 检测结果、性别、年龄组（<50 岁、50-64 岁和>64 岁）和住院状态分层的性能。使用 bootstrap 生成 95%CI，使用 Pearson χ2 检验比较不同亚组。
在 2201 例接受 COVID-19 检测的患者中，平均（SD）年龄为 42（17）岁；1201 例（55%）为女性，1569 例（71%）为白人，282 例（13%）为西班牙裔或拉丁裔。发热的患病率为 66%（1444 例），咳嗽的患病率为 88%（1930 例），呼吸困难的患病率为 64%（1399 例）。对于发热，ICD-10 代码的敏感性为 0.26（95%CI，0.24-0.29），特异性为 0.98（95%CI，0.96-0.99），PPV 为 0.96（95%CI，0.93-0.97），NPV 为 0.41（95%CI，0.39-0.43）。对于咳嗽，ICD-10 代码的敏感性为 0.44（95%CI，0.42-0.46），特异性为 0.88（95%CI，0.84-0.92），PPV 为 0.96（95%CI，0.95-0.97），NPV 为 0.18（95%CI，0.16-0.20）。对于呼吸困难，ICD-10 代码的敏感性为 0.24（95%CI，0.22-0.26），特异性为 0.97（95%CI，0.96-0.98），PPV 为 0.93（95%CI，0.90-0.96），NPV 为 0.42（95%CI，0.40-0.44）。发热和呼吸困难的 ICD-10 代码性能优于门诊患者（χ2=41.30；P<0.001）和（χ2=14.25；P=0.003），但对咳嗽（χ2=5.13；P=0.16）则不然。
这些发现表明，ICD-10 代码缺乏与 COVID-19 相关症状的敏感性，并且 NPV 较差。这种不准确性对任何依赖这些代码的下游数据模型、科学发现或监测都有影响。
