Lynch Kristine E, Viernes Benjamin, Gatsby Elise, DuVall Scott L, Jones Barbara E, Box Tamára L, Kreisler Craig, Jones Makoto
VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Clin Epidemiol. 2021 Oct 27;13:1011-1018. doi: 10.2147/CLEP.S335621. eCollection 2021.
To estimate the positive predictive value (PPV) of International Classification of Diseases, Tenth Revision (ICD-10) code U07.1, COVID-19 virus identified, in the Department of Veterans of Affairs (VA).
Records of ICD-10 code U07.1 from inpatient, outpatient, and emergency/urgent care settings were extracted from VA medical record data from 4/01/2020 to 3/31/2021. A weighted, random sample of 1500 records from each quarter of the one-year observation period was reviewed by study personnel to confirm active COVID-19 infection at the time of diagnosis and classify reasons for false positive records. PPV was estimated overall and compared across clinical setting and quarters.
We identified 664,406 records of U07.1. Among the 1500 reviewed, 237 were false positives (PPV: 84.2%, 95% CI: 82.4-86.0). PPV ranged from 77.7% in outpatient settings to 93.8% in inpatient settings and was 83.3% in quarter 1, 80.5% in quarter 2, 86.1% in quarter 3, and 83.6% in quarter 4. The most common reasons for false positive records were history of COVID-19 (44.3%) and orders for laboratory tests (21.5%).
The PPV of ICD-10 code U07.1 is low, especially in outpatient settings. Directed training may improve accuracy of coding to levels that are deemed adequate for future use in surveillance efforts.
评估美国退伍军人事务部（VA）中，国际疾病分类第十版（ICD - 10）编码U07.1（新冠病毒已识别）的阳性预测值（PPV）。
从2020年4月1日至2021年3月31日的VA医疗记录数据中，提取住院、门诊以及急诊/紧急护理环境下ICD - 10编码U07.1的记录。研究人员对一年观察期内每个季度的1500条记录进行加权随机抽样审查，以确认诊断时的活动性新冠病毒感染情况，并对假阳性记录的原因进行分类。总体评估PPV，并在不同临床环境和季度之间进行比较。
我们识别出664,406条U07.1的记录。在审查的1500条记录中，有237条为假阳性（PPV：84.2%，95%置信区间：82.4 - 86.0）。PPV在门诊环境中为77.7%，在住院环境中为93.8%，第一季度为83.3%，第二季度为80.5%，第三季度为86.1%，第四季度为83.6%。假阳性记录最常见的原因是新冠病毒病史（44.3%）和实验室检查医嘱（21.5%）。
ICD - 10编码U07.1的PPV较低，尤其是在门诊环境中。针对性培训可能会提高编码准确性，使其达到在未来监测工作中被认为足够的水平。
