National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Paediatric Integrated Cancer Service, Royal Children's Hospital, Parkville, Victoria, Australia.
PLoS One. 2020 Sep 9;15(9):e0238889. doi: 10.1371/journal.pone.0238889. eCollection 2020.
Invasive fungal infection (IFI) detection requires application of complex case definitions by trained staff. Administrative coding data (ICD-10-AM) may provide a simplified method for IFI surveillance, but accuracy of case ascertainment in children with cancer is unknown.
To determine the classification performance of ICD-10-AM codes for detecting IFI using a gold-standard dataset (r-TERIFIC) of confirmed IFIs in paediatric cancer patients at a quaternary referral centre (Royal Children's Hospital) in Victoria, Australia from 1st April 2004 to 31st December 2013.
ICD-10-AM codes denoting IFI in paediatric patients (<18-years) with haematologic or solid tumour malignancies were extracted from the Victorian Admitted Episodes Dataset and linked to the r-TERIFIC dataset. Sensitivity, positive predictive value (PPV) and the F1 scores of the ICD-10-AM codes were calculated.
Of 1,671 evaluable patients, 113 (6.76%) had confirmed IFI diagnoses according to gold-standard criteria, while 114 (6.82%) cases were identified using the codes. Of the clinical IFI cases, 68 were in receipt of ≥1 ICD-10-AM code(s) for IFI, corresponding to an overall sensitivity, PPV and F1 score of 60%, respectively. Sensitivity was highest for proven IFI (77% [95% CI: 58-90]; F1 = 47%) and invasive candidiasis (83% [95% CI: 61-95]; F1 = 76%) and lowest for other/unspecified IFI (20% [95% CI: 5.05-72%]; F1 = 5.00%). The most frequent misclassification was coding of invasive aspergillosis as invasive candidiasis.
ICD-10-AM codes demonstrate moderate sensitivity and PPV to detect IFI in children with cancer. However, specific subsets of proven IFI and invasive candidiasis (codes B37.x) are more accurately coded.
侵袭性真菌感染（IFI）的检测需要经过培训的医务人员应用复杂的病例定义。行政编码数据（ICD-10-AM）可能为IFI 监测提供一种简化方法，但在儿童癌症患者中，其病例确定的准确性尚不清楚。
使用澳大利亚维多利亚州四所转诊中心（皇家儿童医院）的儿童癌症患者确诊IFI 的金标准数据集（r-TERIFIC），确定用于检测IFI 的 ICD-10-AM 代码的分类性能。该数据集包含了 2004 年 4 月 1 日至 2013 年 12 月 31 日期间的病例。
从维多利亚州住院记录数据集提取儿科患者（<18 岁）血液系统或实体瘤恶性肿瘤的 IFI ICD-10-AM 编码，并与 r-TERIFIC 数据集进行链接。计算 ICD-10-AM 编码的灵敏度、阳性预测值（PPV）和 F1 分数。
在 1671 例可评估患者中，根据金标准标准，有 113 例（6.76%）被确诊为 IFI，而 114 例（6.82%）通过编码识别。在临床 IFI 病例中，有 68 例接受了至少 1 个 IFI 的 ICD-10-AM 编码，对应的总体灵敏度、PPV 和 F1 分数分别为 60%、60%和 60%。证实的 IFI（77%[95%CI：58-90]；F1=47%）和侵袭性念珠菌病（83%[95%CI：61-95]；F1=76%）的灵敏度最高，而其他/未明确 IFI（20%[95%CI：5.05-72%]；F1=5.00%）的灵敏度最低。最常见的错误分类是编码侵袭性曲霉菌病为侵袭性念珠菌病。
ICD-10-AM 编码对检测儿童癌症患者的 IFI 具有中等的灵敏度和 PPV。然而，特定的 IFI 子集和侵袭性念珠菌病（B37.x 代码）的编码更为准确。
