Centre for Liver Disease Research, The University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia.
Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
BMJ Open Gastroenterol. 2020 Sep;7(1). doi: 10.1136/bmjgast-2020-000485.
The utility of International Classification of Diseases (ICD) codes relies on the accuracy of clinical reporting and administrative coding, which may be influenced by country-specific codes and coding rules. This study explores the accuracy and limitations of the Australian Modification of the 10th revision of ICD (ICD-10-AM) to detect the presence of cirrhosis and a subset of key complications for the purpose of future large-scale epidemiological research and healthcare studies.
DESIGN/METHOD: ICD-10-AM codes in a random sample of 540 admitted patient encounters at a major Australian tertiary hospital were compared with data abstracted from patients' medical records by four blinded clinicians. Accuracy of individual codes and grouped combinations was determined by calculating sensitivity, positive predictive value (PPV), negative predictive value and Cohen's kappa coefficient (κ).
The PPVs for 'grouped cirrhosis' codes (0.96), hepatocellular carcinoma (0.97) ascites (0.97) and 'grouped varices' (0.95) were good (κ all >0.60). However, codes under-detected the prevalence of cirrhosis, ascites and varices (sensitivity 81.4%, 61.9% and 61.3%, respectively). Overall accuracy was lower for spontaneous bacterial peritonitis ('grouped' PPV 0.75; κ 0.73) and the poorest for encephalopathy ('grouped' PPV 0.55; κ 0.21). To optimise detection of cirrhosis-related encounters, an ICD-10-AM code algorithm was constructed and validated in an independent cohort of 116 patients with known cirrhosis.
Multiple ICD-10-AM codes should be considered when using administrative databases to study the burden of cirrhosis and its complications in Australia, to avoid underestimation of the prevalence, morbidity, mortality and related resource utilisation from this burgeoning chronic disease.
国际疾病分类（ICD）代码的实用性依赖于临床报告和行政编码的准确性，而这可能受到特定国家代码和编码规则的影响。本研究旨在探讨澳大利亚修订版第十版国际疾病分类（ICD-10-AM）检测肝硬化及其部分关键并发症的存在的准确性和局限性，以便未来进行大规模的流行病学研究和医疗保健研究。
设计/方法：在澳大利亚一家主要的三级医院的 540 例住院患者中随机抽取样本，比较了 ICD-10-AM 代码与四名盲法临床医生从患者病历中提取的数据。通过计算灵敏度、阳性预测值（PPV）、阴性预测值和 Cohen's kappa 系数（κ），确定了单个代码和组合的准确性。
“肝硬化组合”代码（0.96）、肝细胞癌（0.97）、腹水（0.97）和“静脉曲张组合”（0.95）的 PPV 较高（κ均>0.60）。然而，这些代码对肝硬化、腹水和静脉曲张的检出率较低（灵敏度分别为 81.4%、61.9%和 61.3%）。自发性细菌性腹膜炎（“组合”PPV 为 0.75；κ 值为 0.73）和肝性脑病（“组合”PPV 为 0.55；κ 值为 0.21）的整体准确性较低。为了优化肝硬化相关就诊的检测，我们构建并验证了一种 ICD-10-AM 代码算法，该算法在 116 例已知肝硬化患者的独立队列中得到验证。
在使用管理数据库研究澳大利亚肝硬化及其并发症的负担时，应考虑多个 ICD-10-AM 代码，以避免低估这种日益增多的慢性疾病的患病率、发病率、死亡率和相关资源利用。
