Tanpowpong Pornthep, Lertudomphonwanit Chatmanee, Phuapradit Pornpimon, Treepongkaruna Suporn
Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Clin Exp Pediatr. 2021 Feb;64(2):80-85. doi: 10.3345/cep.2020.00423. Epub 2020 Aug 24.
Although identifying cases in large administrative databases may aid future research studies, previous reports demonstrated that the use of the International Classification of Diseases, Tenth Revision (ICD-10) code alone for diagnosis leads to disease misclassification.
We aimed to assess the value of the ICD-10 diagnostic code for identifying potential children with biliary atresia.
Patients aged <18 years assigned the ICD-10 code of biliary atresia (Q44.2) between January 1996 and December 2016 at a quaternary care teaching hospital were identified. We also reviewed patients with other diagnoses of code-defined cirrhosis to identify more potential cases of biliary atresia. A proposed diagnostic algorithm was used to define ICD-10 code accuracy, sensitivity, and specificity.
We reviewed the medical records of 155 patients with ICD-10 code Q44.2 and 69 patients with other codes for biliary cirrhosis (K74.4, K74.5, K74.6). The accuracy for identifying definite/probable/possible biliary atresia cases was 80%, while the sensitivity was 88% (95% confidence interval [CI], 82%-93%). Three independent predictors were associated with algorithm-defined definite/probable/possible cases of biliary atresia: ICD-10 code Q44.2 (odds ratio [OR], 2.90; 95% CI, 1.09-7.71), history of pale stool (OR, 2.78; 95% CI, 1.18-6.60), and a presumed diagnosis of biliary atresia prior to referral to our hospital (OR, 17.49; 95% CI, 7.01-43.64). A significant interaction was noted between ICD-10 code Q44.2 and a history of pale stool (P<0.05). The area under the curve was 0.87 (95% CI, 0.84-0.89).
ICD-10 code Q44.2 has an acceptable value for diagnosing biliary atresia. Incorporating clinical data improves the case identification. The use of this proposed diagnostic algorithm to examine data from administrative databases may facilitate appropriate health care allocation and aid future research investigations.
虽然在大型管理数据库中识别病例可能有助于未来的研究，但先前的报告表明，仅使用国际疾病分类第十版（ICD-10）代码进行诊断会导致疾病误诊。
我们旨在评估ICD-10诊断代码在识别潜在胆道闭锁儿童方面的价值。
确定了1996年1月至2016年12月期间在一家四级医疗教学医院被分配ICD-10胆道闭锁代码（Q44.2）的18岁以下患者。我们还审查了其他诊断为代码定义肝硬化的患者，以识别更多潜在的胆道闭锁病例。使用一种提议的诊断算法来定义ICD-10代码的准确性、敏感性和特异性。
我们审查了155例ICD-10代码为Q44.2的患者和69例其他胆道肝硬化代码（K74.4、K74.5、K74.6）的患者的病历。识别明确/可能/疑似胆道闭锁病例的准确性为80%，而敏感性为88%（95%置信区间[CI]，82%-93%）。三个独立预测因素与算法定义的明确/可能/疑似胆道闭锁病例相关：ICD-10代码Q44.2（比值比[OR]，2.90；95%CI，1.09-7.71）、白色大便史（OR，2.78；95%CI，1.18-6.60）以及在转诊至我院之前疑似胆道闭锁的诊断（OR，17.49；95%CI，7.01-43.64）。注意到ICD-10代码Q44.2与白色大便史之间存在显著交互作用（P<0.05）。曲线下面积为0.87（95%CI，0.84-0.89）。
ICD-10代码Q44.2在诊断胆道闭锁方面具有可接受的价值。纳入临床数据可改善病例识别。使用这种提议的诊断算法来检查管理数据库中的数据可能有助于合理分配医疗保健资源并辅助未来的研究调查。
