Langlois Anne-Marie, Touchette Charles J, Mathieu David, Iorio-Morin Christian
Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada.
Front Neurol. 2023 Oct 11;14:1244006. doi: 10.3389/fneur.2023.1244006. eCollection 2023.
The International Statistical Classification of Diseases (ICD) classifies subdural hematoma (SDH) as traumatic or non-traumatic. In clinical settings, however, SDH is typically described as either acute or chronic.
The goal of this study was to assess how the ICD Coding Tools captures the clinical terminology and propose an improved classification that would increase the system's usefulness in administrative, statistical and research applications.
We performed a retrospective analysis of patients who presented to our center with an ICD diagnostic code for either traumatic or non-traumatic SDH. A qualitative analysis of patients' charts was performed to identify elements relevant to management and prognosis, following which a meeting between expert investigators was held to elaborate a new classification of SDH. Imaging from all patients was then reviewed and cases were reclassified according to our proposed system.
A total of 277 SDH cases were included. Themes documented in the charts included chronicity, etiology, side, and symptoms. We created a new classification which distinguishes acute SDH (aSDH) from membrane-associated SDH (mSDH). aSDH were further divided into traumatic aSDH (taSDH) and non-traumatic aSDH (ntaSDH), while mSDH were divided into acute on chronic (a/cSDH), subacute (sSDH) and chronic (cSDH) categories.
The ICD coding system correctly identifies taSDH and ntaSDH. However, it remains non-specific for mSDH. We propose this new SDH classification system to better capture chronicity and etiology - factors felt to impact management and prognosis.
《国际疾病分类》（ICD）将硬膜下血肿（SDH）分为创伤性或非创伤性。然而，在临床环境中，SDH通常被描述为急性或慢性。
本研究的目的是评估ICD编码工具如何捕捉临床术语，并提出一种改进的分类方法，以提高该系统在行政、统计和研究应用中的实用性。
我们对以创伤性或非创伤性SDH的ICD诊断代码就诊于我们中心的患者进行了回顾性分析。对患者病历进行定性分析，以确定与管理和预后相关的因素，随后专家研究人员召开会议，详细制定SDH的新分类。然后对所有患者的影像学资料进行回顾，并根据我们提出的系统对病例进行重新分类。
共纳入277例SDH病例。病历中记录的主题包括慢性、病因、部位和症状。我们创建了一种新的分类方法，将急性SDH（aSDH）与膜相关性SDH（mSDH）区分开来。aSDH进一步分为创伤性aSDH（taSDH）和非创伤性aSDH（ntaSDH），而mSDH分为慢性基础上急性发作（a/cSDH）、亚急性（sSDH）和慢性（cSDH）类别。
ICD编码系统能正确识别taSDH和ntaSDH。然而，对于mSDH它仍然不具有特异性。我们提出这种新的SDH分类系统，以更好地体现慢性和病因——这些被认为会影响管理和预后的因素。
