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大疱性类天疱疮的准确诊断需要多次就诊。

Accurate diagnosis of bullous pemphigoid requires multiple health care visits.

机构信息

Department of Dermatology, Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.

Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

出版信息

Front Immunol. 2023 Nov 27;14:1281302. doi: 10.3389/fimmu.2023.1281302. eCollection 2023.

DOI:10.3389/fimmu.2023.1281302
PMID:38090583
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10711056/
Abstract

INTRODUCTION

Accurate use of diagnostic codes is crucial for epidemiological and genetic research based on electronic health record (EHR) data.

METHODS

This retrospective study validated the International Classification of Diseases (ICD)-10 diagnostic code L12.0 for bullous pemphigoid (BP) using EHR data from two Finnish university hospitals. We found 1225 subjects with at least one EHR entry of L12.0 between 2009 and 2019. BP diagnosis was based on clinical findings characteristic of BP and positive findings on direct immunofluorescence (DIF), BP180-NC16A enzyme-linked immunosorbent assay (ELISA) or indirect immunofluorescence (IIF) assay.

RESULTS

True BP was found in 901 patients; the positive predictive value (PPV) for L12.0 was 73.6% (95% CI 71.0-76.0). L12.0 was more accurately registered in dermatology units than any specialized health care units (p<0.001). Including patients with multiple L12.0 registrations (≥3), increased the accuracy of the L12.0 code in both dermatology units and other settings.

DISCUSSION

One diagnostic code of L12.0 is not enough to recognize BP in a large epidemiological data set; including only L12.0 registered in dermatology units and excluding cases with <3 L12.0 record entries markedly increases the PPV of BP diagnosis.

摘要

简介

准确使用诊断代码对于基于电子健康记录 (EHR) 数据的流行病学和遗传研究至关重要。

方法

本回顾性研究使用芬兰两所大学医院的 EHR 数据验证了国际疾病分类第 10 版 (ICD-10) 诊断代码 L12.0 用于大疱性类天疱疮 (BP) 的准确性。我们在 2009 年至 2019 年间发现了 1225 名至少有一次 EHR 记录为 L12.0 的患者。BP 诊断基于 BP 的临床特征和直接免疫荧光 (DIF)、BP180-NC16A 酶联免疫吸附测定 (ELISA) 或间接免疫荧光 (IIF) 检测的阳性发现。

结果

901 名患者中发现了真正的 BP；L12.0 的阳性预测值 (PPV) 为 73.6%（95%CI 71.0-76.0）。L12.0 在皮肤科单位的登记比任何专门的医疗保健单位都更准确（p<0.001）。包括多个 L12.0 登记（≥3）的患者，增加了皮肤科单位和其他环境中 L12.0 代码的准确性。

讨论

一个 L12.0 诊断代码不足以在大型流行病学数据集识别 BP；仅包括在皮肤科单位登记的 L12.0 并排除 <3 次 L12.0 记录条目的病例，明显提高了 BP 诊断的 PPV。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7d70/10711056/39c63943ee88/fimmu-14-1281302-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7d70/10711056/d9cb0fe64930/fimmu-14-1281302-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7d70/10711056/39c63943ee88/fimmu-14-1281302-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7d70/10711056/d9cb0fe64930/fimmu-14-1281302-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7d70/10711056/39c63943ee88/fimmu-14-1281302-g002.jpg

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