Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
Pharmacoepidemiol Drug Saf. 2023 Dec;32(12):1439-1445. doi: 10.1002/pds.5675. Epub 2023 Aug 1.
This study validated incident and recurrent ischemic stroke identified by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) hospital discharge diagnosis codes.
Using electronic health records (EHR) of adults (≥18 years) receiving care from Kaiser Permanente Southern California with ICD-10 hospital discharge diagnosis codes of ischemic stroke (I63.x, G46.3, and G46.4) between October 2015 and September 2020, we identified 75 patients with both incident and recurrent stroke events (total 150 cases). Two neurologists independently evaluated validity of ICD-10 codes through chart reviews.
The positive predictive value (PPV, 95% CI) for incident stroke was 93% (95% CI: 88%, 99%) and the PPV for recurrent stroke was 72% (95% CI: 62%, 82%). The PPV for recurrent stroke improved after applying a gap of 20 days (PPV of 75%; 95% CI: 63%, 87%) or removing hospital admissions related to stroke-related procedures (PPV of 78%; 95% CI: 68%, 88%).
The ICD-10 hospital discharge diagnosis codes for ischemic stroke showed a high PPV for incident cases, while the PPV for recurrent cases were less optimal. Algorithms to improve the accuracy of ICD-10 codes for recurrent ischemic stroke may be necessary.
本研究验证了通过国际疾病分类第十次修订版临床修订版（ICD-10）出院诊断代码识别的偶发性和复发性缺血性卒中。
使用 Kaiser Permanente Southern California 的电子健康记录（EHR），纳入 2015 年 10 月至 2020 年 9 月期间 ICD-10 出院诊断代码为缺血性卒中（I63.x、G46.3 和 G46.4）的≥18 岁成年人，共 75 名患者发生了偶发性和复发性卒中事件（共 150 例）。两名神经科医生通过病历审查独立评估 ICD-10 代码的有效性。
偶发性卒中的阳性预测值（PPV，95%置信区间）为 93%（95%置信区间：88%，99%），而复发性卒中的 PPV 为 72%（95%置信区间：62%，82%）。应用 20 天间隔（PPV 为 75%；95%置信区间：63%，87%）或去除与卒中相关程序相关的住院（PPV 为 78%；95%置信区间：68%，88%）后，复发性卒中的 PPV 提高。
ICD-10 缺血性卒中出院诊断代码对偶发性病例具有较高的 PPV，而复发性病例的 PPV 则不太理想。可能需要制定算法来提高 ICD-10 复发性缺血性卒中代码的准确性。
