探讨新 ICD-10-CM 分类系统对伤害监测的影响：来自两个医疗中心的双重编码数据分析。

Exploring the implications of the new ICD-10-CM classification system for injury surveillance: analysis of dually coded data from two medical centres.

机构信息

Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA

School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA.

出版信息

Inj Prev. 2021 Mar;27(S1):i19-i26. doi: 10.1136/injuryprev-2019-043519.

DOI:10.1136/injuryprev-2019-043519

PMID:33674329

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7948193/

Abstract

INTRODUCTION

External cause of injury matrices is used to classify mechanisms/causes of injuries for surveillance and research. Little is known about the performance of the Centers for Disease Control and Prevention's new external cause of injury matrix for Clinical Modification of the 10th Revision of the International Classification of Diseases (ICD-10-CM), compared with the ICD-9-CM version.

METHODS

Dually coded (ICD-9-CM and ICD-10-CM) administrative data were obtained from two major academic trauma centres. Injury-related cases were identified and categorised by mechanism/cause and manner/intent. Comparability ratios (CR) were used to estimate the net impact of changing from ICD-9-CM to ICD-10-CM on the number of cases classified to each mechanism/cause category. Chamberlain's percent positive agreements (PPA) were calculated and McNemar's test was used to assess the significance of observed classification differences.

RESULTS

Of 4832 and 5211 dual-coded records from the two centres, 632 and 520 with injury-related principal diagnoses and external cause codes in both ICD-9-CM and ICD-10-CM were identified. CRs for the mechanisms/causes with at least 20 records ranged from 0.85 to 1.9 at one centre and from 0.97 to 1.07 at the other. Among these mechanisms/causes, PPAs ranged from 33% for 'other transport' to 94% for poisoning at one centre, and from 75% for 'other transport' to 100% for fires/burns at the other centre. Case assignment differed significantly for falls, motor vehicle traffic, other transport, and 'struck by/against' injuries at one centre, and for 'other pedal cyclist' at the other centre.

CONCLUSION

Switching to ICD-10-CM and the new external cause of injury matrix may affect injury surveillance and research, especially for certain mechanisms/causes.

摘要

简介

伤害外部原因矩阵用于对伤害的机制/原因进行分类，以进行监测和研究。与 ICD-9-CM 版本相比，人们对疾病控制与预防中心（CDC）新的伤害外部原因矩阵用于国际疾病分类第 10 次修订版临床修正（ICD-10-CM）的性能知之甚少。

方法

从两个主要的学术创伤中心获得双重编码（ICD-9-CM 和 ICD-10-CM）的行政数据。通过机制/原因和方式/意图对与伤害相关的病例进行分类和分类。可比性比率（CR）用于估计从 ICD-9-CM 转换为 ICD-10-CM 对分类为每个机制/原因类别的病例数量的净影响。计算张伯伦的阳性一致率（PPA），并使用 McNemar 检验评估观察到的分类差异的显著性。

结果

从两个中心的 4832 份和 5211 份双重编码记录中，确定了 632 份和 520 份具有 ICD-9-CM 和 ICD-10-CM 中与伤害相关的主要诊断和外部原因代码的记录。至少有 20 条记录的机制/原因的 CR 范围为一个中心的 0.85 至 1.9，另一个中心的 0.97 至 1.07。在这些机制/原因中，一个中心的“其他运输”的 PPA 范围为 33%，中毒为 94%，另一个中心的“其他运输”为 75%，火灾/烧伤为 100%。一个中心的跌倒、机动车交通、其他运输和“被/撞”伤害以及另一个中心的“其他踏板车”的病例分配差异显著。