Dunne Cody L, Cirone Julia, McRae Andrew D, Blanchard Ian, Holroyd-Ledu Jayna, Sauro Khara
Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Resusc Plus. 2023 Oct 6;16:100479. doi: 10.1016/j.resplu.2023.100479. eCollection 2023 Dec.
To validate a case definition for foreign body airway obstructions (FBAO) using International Classification of Diseases version 10 (ICD-10) codes to accurately identify patients in administrative health databases and improve reporting on this injury.
We identified prehospital patient encounters in Alberta, Canada between Jan 1, 2018 and Dec 31, 2021 by querying the provincial emergency medical services' (EMS) patient care records for FBAO-related presentations, EMS protocols, or treatments. We deterministically linked EMS patient encounters to data on emergency department visits and hospital admissions, which included ICD-10 codes. Two physicians independently reviewed encounters to determine true FBAO cases. We then calculated diagnostic accuracy measures (sensitivity, specificity, likelihood ratios) of various algorithms.
We identified 3677 EMS patient encounters, 2121 were linked to hospital administrative databases. Of these encounters, 825 (38.9%) were true FBAO. The combination of two ICD-10 codes (T17 = foreign body in the respiratory tract or T18.0 = foreign body in the mouth) was the most specific algorithm (96.9% [95%CI 95.8-97.8%]), while the combination of all FBAO-related ICD-10 codes and R06.8 (other breathing abnormalities) was the most sensitive (75.0% [95%CI 71.9-78.0]). We identified an additional 453 (35.4%) FBAO cases not transported by EMS (due to death or transport refusal), and therefore not linked to the hospital administrative databases. Of these unlinked encounters, 44 (9.7%) cases resulted in the patient's death.
FBAO can be identified with reasonable accuracy using health administrative data and ICD-10 codes. All algorithms had a trade-off between sensitivity and specificity, and failed to identify a third of FBAO cases, of which 10% resulted in death.
使用国际疾病分类第10版（ICD - 10）编码验证异物气道梗阻（FBAO）的病例定义，以便在行政卫生数据库中准确识别患者，并改进对此类损伤的报告。
我们通过查询加拿大艾伯塔省省级紧急医疗服务（EMS）的患者护理记录，以获取与FBAO相关的就诊情况、EMS协议或治疗方法，从而确定2018年1月1日至2021年12月31日期间的院前患者就诊情况。我们将EMS患者就诊情况与急诊科就诊和住院数据进行确定性关联，这些数据包括ICD - 10编码。两名医生独立审查就诊情况以确定真正的FBAO病例。然后我们计算了各种算法的诊断准确性指标（敏感性、特异性、似然比）。
我们确定了3677次EMS患者就诊情况，其中2121次与医院行政数据库相关联。在这些就诊情况中，825例（38.9%）为真正的FBAO。两个ICD - 10编码（T17 = 呼吸道异物或T18.0 = 口腔异物）的组合是最具特异性的算法（96.9% [95%CI 95.8 - 97.8%]），而所有与FBAO相关的ICD - 10编码和R06.8（其他呼吸异常）的组合是最敏感的（75.0% [95%CI 71.9 - 78.0]）。我们还识别出另外453例（35.4%）未由EMS转运的FBAO病例（由于死亡或拒绝转运），因此未与医院行政数据库相关联。在这些未关联的就诊情况中，44例（9.7%）导致患者死亡。
使用卫生行政数据和ICD - 10编码可以合理准确地识别FBAO。所有算法在敏感性和特异性之间都存在权衡，并且未能识别出三分之一的FBAO病例，其中10%导致死亡。
