Campanile Yael, Silverman Michael
Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Am J Drug Alcohol Abuse. 2022 Sep 3;48(5):538-547. doi: 10.1080/00952990.2022.2047713. Epub 2022 May 17.
Healthcare databases have the potential to become efficient tools for epidemiological research in People Who Inject Drugs (PWID). The validity of ICD-10 codes for specific substances in this population has not been assessed. Validate ICD-10 diagnosis codes relating to the use of specific substance classes in a cohort of endocarditis patients. Our study sample consisted of 379 first-episode infective endocarditis patients (Male: 208, Female: 171), aged 18-55, admitted to any of three hospitals in London, Ontario from 2007 to 2018. Of these, 287 used drugs. We validated ICD-10 substance use codes for opioids (F11), stimulants (F15), cocaine (F14) and multiple substances (F19). Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated for each code, using self-reported substance use documented on medical record review as a gold standard. We conducted a comparative analysis between code-negative users and code-positive users for each substance. All substance use codes shared the same pattern: high specificity, high PPV and low sensitivity, with code F11 yielding the highest PPV (96.3%; 95% C.I.: 90.8-98.6) and sensitivity (42.6%; 95% C.I. 36.3-49.1). The code-positives and code-negatives for each substance did not differ significantly in any characteristics compared. Our results suggest that the individual ICD-10 codes analyzed should not be used for research without adjustment for low sensitivity. However, due to high PPV and specificity, these codes may still have potential for research use. Because code-negative patients did not differ from code-positive patients, their data may be extrapolated to the overall group of substance users.
医疗保健数据库有潜力成为注射吸毒者（PWID）流行病学研究的有效工具。该人群中特定物质的国际疾病分类第十版（ICD - 10）编码的有效性尚未得到评估。验证一组心内膜炎患者中与特定物质类别使用相关的ICD - 10诊断编码。我们的研究样本包括2007年至2018年期间入住安大略省伦敦市三家医院中任何一家的379例首发感染性心内膜炎患者（男性：208例，女性：171例），年龄在18 - 55岁之间。其中，287人使用过毒品。我们验证了阿片类药物（F11）、兴奋剂（F15）、可卡因（F14）和多种物质（F19）的ICD - 10物质使用编码。将病历审查中记录的自我报告物质使用情况作为金标准，计算每个编码的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。我们对每种物质的编码阴性使用者和编码阳性使用者进行了比较分析。所有物质使用编码都呈现相同模式：高特异性、高PPV和低敏感性，编码F11的PPV最高（96.3%；95%置信区间：90.8 - 98.6），敏感性为（42.6%；95%置信区间36.3 - 49.1）。每种物质的编码阳性者和编码阴性者在任何特征上均无显著差异。我们的结果表明，所分析的单个ICD - 10编码在未针对低敏感性进行调整的情况下不应用于研究。然而，由于高PPV和特异性，这些编码可能仍具有研究用途。因为编码阴性患者与编码阳性患者没有差异，他们的数据可以外推到整个物质使用者群体。
