Arthur Rodney, Mayberry R Miles, Odum Susan, Kempton Laurence B
University of North Carolina School of Medicine, Chapel Hill, NC.
Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, NC.
OTA Int. 2024 Feb 29;7(1):e307. doi: 10.1097/OI9.0000000000000307. eCollection 2024 Mar.
The 10th revision of the International Classification of Diseases (ICD-10) coding system may prove useful to orthopaedic trauma researchers to identify and document populations based on comorbidities. However, its use for research first necessitates determination of its reliability. The purpose of this study was to assess the reliability of electronic medical record (EMR) ICD-10 coding of nonorthopaedic diagnoses in orthopaedic trauma patients relative to the gold standard of prospective data collection.
Nonexperimental cross-sectional study.
Level 1 Trauma Center.
PATIENTS/PARTICIPANTS: Two hundred sixty-three orthopaedic trauma patients from 2 prior prospective studies from September 2018 to April 2022.
Prospectively collected data were compared with EMR ICD-10 code abstraction for components of the Charlson Comorbidity Index (CCI), obesity, alcohol abuse, and tobacco use (retrospective data).
Percent agreement and Cohen's kappa reliability.
Percent agreement ranged from 86.7% to 96.9% for all CCI diagnoses and was as low as 72.6% for the diagnosis "overweight." Only 2 diagnoses, diabetes without end-organ damage (kappa = 0.794) and AIDS (kappa = 0.798) demonstrated Cohen's kappa values to indicate substantial agreement.
EMR diagnostic coding for medical comorbidities in orthopaedic trauma patients demonstrated variable reliability. Researchers may be able to rely on EMR coding to identify patients with diabetes without complications or AIDS. Chart review may still be necessary to confirm diagnoses. Low prevalence of most comorbidities led to high percentage agreement with low reliability.
Level 1 diagnostic.
国际疾病分类第十版（ICD - 10）编码系统可能对骨科创伤研究人员根据合并症识别和记录人群有用。然而，将其用于研究首先需要确定其可靠性。本研究的目的是评估骨科创伤患者非骨科诊断的电子病历（EMR）ICD - 10编码相对于前瞻性数据收集金标准的可靠性。
非实验性横断面研究。
一级创伤中心。
患者/参与者：来自2018年9月至2022年4月之前两项前瞻性研究的263名骨科创伤患者。
将前瞻性收集的数据与Charlson合并症指数（CCI）、肥胖、酒精滥用和烟草使用（回顾性数据）组成部分的EMR ICD - 10编码摘要进行比较。
一致性百分比和Cohen's kappa可靠性。
所有CCI诊断的一致性百分比范围为86.7%至96.9%，“超重”诊断的一致性百分比低至72.6%。只有2种诊断，即无终末器官损害的糖尿病（kappa = 0.794）和艾滋病（kappa = 0.798），其Cohen's kappa值表明具有实质性一致性。
骨科创伤患者医疗合并症的EMR诊断编码显示出不同的可靠性。研究人员可能能够依靠EMR编码来识别无并发症的糖尿病患者或艾滋病患者。仍可能需要查阅病历以确认诊断。大多数合并症的低患病率导致一致性百分比高但可靠性低。
一级诊断。
