Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.
Department of Rheumatology, Skåne University Hospital, Lund, Sweden.
Scand J Rheumatol. 2023 Jul;52(4):374-384. doi: 10.1080/03009742.2022.2066807. Epub 2022 Jun 6.
: Knowledge of the correspondence between clinical ICD diagnoses and classification criteria fulfilment is crucial to interpret studies identifying cases via ICD codes. We assessed the degree to which patients registered with ICD-10 diagnoses of psoriatic arthritis (PsA) in the Swedish National Patient Register (NPR) fulfil established PsA classification criteria.
Four hundred patients with at least one outpatient visit to one of five rheumatology or internal medicine departments (three university/two county departments across Sweden) in 2013-2015, with a main ICD-10 diagnosis of PsA (L40.5, M07.0-M07.3), were randomly selected (80 cases/site). Through a structured medical record review, positive predictive values (PPVs) for fulfilment of the following classification criteria were assessed: CASPAR, Moll and Wright, Vasey and Espinoza, and modified ESSG criteria for PsA. A subset analysis regarding CASPAR fulfilment was also performed among cases with available rheumatoid factor and peripheral X-ray status (central CASPAR items; n = 227).
Of the 400 patients with a main ICD-10 diagnosis of PsA, 343 (86%) fulfilled at least one of the four PsA classification criteria. PPVs for the different criteria were: CASPAR 69% (82% in the subset analysis), Moll and Wright 51%, Vasey and Espinoza 76%, and modified ESSG 64%. Overall, only 6.5% of the 400 PsA diagnoses were judged as clearly incorrect by the medical record reviewers.
The validity of rheumatologist-made, clinical ICD-10 diagnoses for PsA in the Swedish NPR is good, with PPVs of 69-82% for CASPAR fulfilment and 86% for meeting any established PsA classification criteria.
了解临床 ICD 诊断与分类标准符合程度对于通过 ICD 编码识别病例的研究至关重要。我们评估了在瑞典国家患者登记处（NPR）中，以 ICD-10 诊断为银屑病关节炎（PsA）登记的患者符合既定 PsA 分类标准的程度。
2013 年至 2015 年期间，我们从瑞典五个风湿病或内科部门（三家大学/两家县部门）至少有一次门诊就诊、主要 ICD-10 诊断为 PsA（L40.5、M07.0-M07.3）的 400 名患者中随机选择（每个部位 80 例）。通过结构化病历回顾，评估了以下分类标准符合率的阳性预测值（PPV）：CASPAR、Moll 和 Wright、Vasey 和 Espinoza 以及改良 ESSG 标准。还对有可用类风湿因子和外周 X 射线状态的病例（中央 CASPAR 项目；n=227）进行了 CASPAR 符合情况的亚组分析。
在 400 名主要 ICD-10 诊断为 PsA 的患者中，有 343 名（86%）符合至少一项四项 PsA 分类标准。不同标准的 PPV 如下：CASPAR 为 69%（亚组分析中为 82%）、Moll 和 Wright 为 51%、Vasey 和 Espinoza 为 76%、改良 ESSG 为 64%。总体而言，仅有 400 例 PsA 诊断中的 6.5%被病历审阅者判断为明显不正确。
瑞典 NPR 中风湿病学家基于临床 ICD-10 诊断的 PsA 具有良好的有效性，CASPAR 符合率的 PPV 为 69-82%，符合任何既定的 PsA 分类标准的符合率为 86%。
