Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, 222 Maijin Rd, Keelung, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
J Med Syst. 2023 Sep 11;47(1):97. doi: 10.1007/s10916-023-01989-2.
Real-world data sources can facilitate essential understanding of the epidemiological features of anaphylaxis. However, the accuracy of case-identifying definitions based on diagnosis codes for anaphylaxis in healthcare databases remains understudied. We conducted a cross-sectional study analyzing claims data from the largest multi-institutional healthcare system in Taiwan during 2017-2021. We included patients with incident anaphylaxis identified by either ICD-10-CM codes for anaphylaxis (Group 1) or ICD-10-CM codes for severe allergic or drug adverse events and additional modifier codes for acute allergy events (Group 2). We randomly selected 20% of the cases to determine the positive predictive value (PPV) of anaphylaxis case-identifying definitions in Groups 1 and 2 after review of electronic medical records by two physicians. From the original cohort (n = 2,176), we randomly selected 433 patients with either a diagnosis of anaphylaxis (Group 1), or a diagnosis of severe allergic and drug adverse events with additional modifier codes for acute allergy events (Group 2). In Group 1, we judged 135 / 170 patients as true anaphylaxis cases, giving a PPV of 79.4% (95% CI: 73.3-85.5). In Group 2, we judged 47 / 263 patients as true anaphylaxis cases, giving a PPV of 17.9% (95% CI: 13.3-22.5). In conclusion, acceptable PPVs were observed when anaphylaxis cases were identified by ICD-10-CM codes for anaphylaxis, but not by ICD-10-CM codes for severe allergic or drug adverse event with additional modifier codes for acute allergy events. Our multi-institutional findings could serve as a fundamental reference for further studies of anaphylaxis based on real-world healthcare databases.
真实世界的数据来源可以促进对过敏反应的流行病学特征的深入了解。然而，基于医疗保健数据库中过敏反应的诊断代码来确定过敏反应病例的准确性仍有待研究。我们进行了一项横断面研究，分析了 2017 年至 2021 年期间台湾最大的多机构医疗保健系统的索赔数据。我们纳入了通过过敏反应的 ICD-10-CM 代码（第 1 组）或严重过敏或药物不良反应的 ICD-10-CM 代码以及急性过敏事件的附加修饰符代码（第 2 组）确定的过敏反应事件的患者。我们随机选择了 20%的病例，以确定在两位医生审查电子病历后，第 1 组和第 2 组的过敏反应病例识别定义的阳性预测值（PPV）。从原始队列（n=2176）中，我们随机选择了 433 名患者，他们要么被诊断为过敏反应（第 1 组），要么被诊断为严重过敏和药物不良反应，并有急性过敏事件的附加修饰符代码（第 2 组）。在第 1 组中，我们判断 135/170 名患者为真正的过敏反应病例，PPV 为 79.4%（95%CI：73.3-85.5）。在第 2 组中，我们判断 47/263 名患者为真正的过敏反应病例，PPV 为 17.9%（95%CI：13.3-22.5）。总之，当通过过敏反应的 ICD-10-CM 代码识别过敏反应病例时，观察到可接受的 PPV，但当通过包含急性过敏事件附加修饰符代码的 ICD-10-CM 代码识别严重过敏或药物不良反应病例时，PPV 则不可接受。我们的多机构研究结果可为基于真实医疗保健数据库的过敏反应进一步研究提供基本参考。
