San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, California, 94102, USA; University of California, Berkeley, 2121 Berkeley Way, 5th Floor, Berkeley, California, 94702, USA.
San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, California, 94102, USA; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, California, 94143, USA.
Drug Alcohol Depend. 2021 Apr 1;221:108537. doi: 10.1016/j.drugalcdep.2021.108537. Epub 2021 Jan 20.
Understanding whether International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes can be used to accurately detect substance use can inform their use in future surveillance and research efforts.
Using 2015-2018 data from a retrospective cohort study of 602 safety-net patients prescribed opioids for chronic non-cancer pain, we calculated the sensitivity and specificity of using ICD-10-CM codes to detect illicit substance use compared to retrospective self-report by substance (methamphetamine, cocaine, opioids [heroin or non-prescribed opioid analgesics]), self-reported use frequency, and type of healthcare encounter.
Sensitivity of ICD-10-CM codes for detecting self-reported substance use was highest for methamphetamine (49.5 % [95 % confidence interval: 39.6-59.5 %]), followed by cocaine (44.4 % [35.8-53.2 %]) and opioids (36.3 % [28.8-44.2 %]); higher for participants who reported more frequent methamphetamine (intermittent use: 27.7 % [14.6-42.6 %]; ≥weekly use: 67.2 % [53.7-79.0 %]) and opioid use (intermittent use: 21.4 % [13.2-31.7 %]; ≥weekly use: 52.6 % [40.8-64.2 %]); highest for outpatient visits (methamphetamine: 43.8 % [34.1-53.8 %]; cocaine: 36.8 % [28.6-45.6 %]; opioids: 33.1 % [25.9-41.0 %]) and lowest for emergency department visits (methamphetamine: 8.6 % [4.0-15.6 %]; cocaine: 5.3 % [2.1-10.5 %]; opioids: 6.3 % [3.0-11.2 %]). Specificity was highest for methamphetamine (96.4 % [94.3-97.8 %]), followed by cocaine (94.0 % [91.5-96.0 %]) and opioids (85.0 % [81.3-88.2 %]).
ICD-10-CM codes had high specificity and low sensitivity for detecting self-reported substance use but were substantially more sensitive in detecting frequent use. ICD-10-CM codes to detect substance use, particularly those from emergency department visits, should be used with caution, but may be useful as a lower-bound population measure of substance use or for capturing frequent use among certain patient populations.
了解国际疾病分类第 10 次修订版临床修订本（ICD-10-CM）代码是否可用于准确检测物质使用情况，可以为今后的监测和研究工作提供参考。
我们使用了 2015 年至 2018 年期间一项回顾性队列研究中的数据，该研究纳入了 602 名因慢性非癌症疼痛而开处阿片类药物的患者，我们计算了使用 ICD-10-CM 代码检测物质使用情况的灵敏度和特异性，将其与物质（冰毒、可卡因、阿片类药物[海洛因或非处方阿片类镇痛药]）的回顾性自我报告、自我报告的使用频率以及医疗保健类型进行比较。
ICD-10-CM 代码检测自我报告物质使用的灵敏度，冰毒最高（49.5%[95%置信区间：39.6%-59.5%]），其次是可卡因（44.4%[35.8%-53.2%]）和阿片类药物（36.3%[28.8%-44.2%]）；在报告使用冰毒更频繁的参与者中（间歇性使用：27.7%[14.6%-42.6%]；每周≥1 次：67.2%[53.7%-79.0%]）和阿片类药物（间歇性使用：21.4%[13.2%-31.7%]；每周≥1 次：52.6%[40.8%-64.2%]）中，灵敏度更高；在门诊就诊中最高（冰毒：43.8%[34.1%-53.8%]；可卡因：36.8%[28.6%-45.6%]；阿片类药物：33.1%[25.9%-41.0%]），在急诊就诊中最低（冰毒：8.6%[4.0%-15.6%]；可卡因：5.3%[2.1%-10.5%]；阿片类药物：6.3%[3.0%-11.2%]）。特异性方面，冰毒最高（96.4%[94.3%-97.8%]），其次是可卡因（94.0%[91.5%-96.0%]）和阿片类药物（85.0%[81.3%-88.2%]）。
ICD-10-CM 代码在检测自我报告的物质使用情况方面具有较高的特异性和较低的灵敏度，但在检测频繁使用方面则更为敏感。ICD-10-CM 代码用于检测物质使用情况，特别是来自急诊就诊的代码，应谨慎使用，但对于捕捉特定人群中的频繁使用情况或作为物质使用的下限人群指标，可能具有一定的应用价值。
