Galanis Eleni, Goshtasebi Azita, Hung Yuen Wai, Chan Jonathan, Matsell Douglas, Chapman Kristine, Kaplan Gilaad, Patrick David, Zhang Bei Yuan, Taylor Marsha, Panagiotoglou Dimitra, Majowicz Shannon
Faculty of Medicine, University of British Columbia, Vancouver, BC.
British Columbia Centre for Disease Control, Vancouver, BC.
Can Commun Dis Rep. 2023 Aug 1;49(7-8):229-309. doi: 10.14745/ccdr.v49i78a01.
Enteric infections and their chronic sequelae are a major cause of disability and death. Despite the increasing use of administrative health data in measuring the burden of chronic diseases in the population, there is a lack of validated International Classification of Disease (ICD) code-based case definitions, particularly in the Canadian context. Our objective was to validate ICD code definitions for sequelae of enteric infections in Canada: acute kidney injury (AKI); hemolytic uremic syndrome (HUS); thrombotic thrombocytopenic purpura (TTP); Guillain-Barré syndrome/Miller-Fisher syndrome (GBS/MFS); chronic inflammatory demyelinating polyneuropathy (CIDP); ankylosing spondylitis (AS); reactive arthritis; anterior uveitis; Crohn's disease, ulcerative colitis, celiac disease, erythema nodosum (EN); neonatal listeriosis (NL); and Graves' disease (GD).
We used a multi-step approach by conducting a literature review to identify existing validated definitions, a clinician assessment of the validated definitions, a chart review to verify proposed definitions and a final clinician review. We measured the sensitivity and positive predictive value (PPV) of proposed definitions.
Forty studies met inclusion criteria. We identified validated definitions for 12 sequelae; clinicians developed three (EN, NL, GD). We reviewed 181 charts for 6 sequelae (AKI, HUS, TTP, GBS/MFS, CIDP, AS). Sensitivity (42.8%-100%) and PPV (63.6%-100%) of ICD code definitions varied. Six definitions were modified by clinicians following the chart review (AKI, TTP, GBS/MFS, CIDP, AS, reactive arthritis) to reflect coding practices, increase specificity or sensitivity, and address logistical constraints.
The multi-step design to derive ICD code definitions provided flexibility to identify existing definitions, to improve their sensitivity and PPV and adapt them to the Canadian context.
肠道感染及其慢性后遗症是导致残疾和死亡的主要原因。尽管行政健康数据在衡量人群慢性病负担方面的使用日益增加，但缺乏经过验证的基于国际疾病分类（ICD）编码的病例定义，尤其是在加拿大的背景下。我们的目标是验证加拿大肠道感染后遗症的ICD编码定义：急性肾损伤（AKI）；溶血尿毒综合征（HUS）；血栓性血小板减少性紫癜（TTP）；吉兰-巴雷综合征/米勒-费希尔综合征（GBS/MFS）；慢性炎症性脱髓鞘性多发性神经病（CIDP）；强直性脊柱炎（AS）；反应性关节炎；前葡萄膜炎；克罗恩病、溃疡性结肠炎、乳糜泻、结节性红斑（EN）；新生儿李斯特菌病（NL）；以及格雷夫斯病（GD）。
我们采用了多步骤方法，进行文献综述以确定现有的经过验证的定义，由临床医生对经过验证的定义进行评估，通过病历审查来验证提议的定义，最后由临床医生进行审查。我们测量了提议定义的敏感性和阳性预测值（PPV）。
40项研究符合纳入标准。我们确定了12种后遗症的经过验证的定义；临床医生制定了3种（EN、NL、GD）。我们审查了181份病历，涉及6种后遗症（AKI、HUS、TTP、GBS/MFS、CIDP、AS）。ICD编码定义的敏感性（42.8%-100%）和PPV（63.6%-100%）各不相同。临床医生在病历审查后对6种定义进行了修改（AKI、TTP、GBS/MFS、CIDP、AS、反应性关节炎），以反映编码实践、提高特异性或敏感性，并解决后勤方面的限制。
得出ICD编码定义的多步骤设计提供了灵活性，可用于识别现有定义、提高其敏感性和PPV，并使其适应加拿大的情况。
