Department of Obstetrics and Gynecology, Stanford University, Stanford, California, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA.
Paediatr Perinat Epidemiol. 2024 Jul;38(5):435-439. doi: 10.1111/ppe.13076. Epub 2024 Mar 21.
The 10th revision of the International Classification of Diseases, Clinical Modification (ICD-10) includes diagnosis codes for placenta accreta spectrum for the first time. These codes could enable valuable research and surveillance of placenta accreta spectrum, a life-threatening pregnancy complication that is increasing in incidence.
We sought to evaluate the validity of placenta accreta spectrum diagnosis codes that were introduced in ICD-10 and assess contributing factors to incorrect code assignments.
We calculated sensitivity, specificity, positive predictive value and negative predictive value of the ICD-10 placenta accreta spectrum code assignments after reviewing medical records from October 2015 to March 2020 at a quaternary obstetric centre. Histopathologic diagnosis was considered the gold standard.
Among 22,345 patients, 104 (0.46%) had an ICD-10 code for placenta accreta spectrum and 51 (0.23%) had a histopathologic diagnosis. ICD-10 codes had a sensitivity of 0.71 (95% CI 0.56, 0.83), specificity of 0.98 (95% CI 0.93, 1.00), positive predictive value of 0.61 (95% CI 0.48, 0.72) and negative predictive value of 1.00 (95% CI 0.96, 1.00). The sensitivities of the ICD-10 codes for placenta accreta spectrum subtypes- accreta, increta and percreta-were 0.55 (95% CI 0.31, 0.78), 0.33 (95% CI 0.12, 0.62) and 0.56 (95% CI 0.31, 0.78), respectively. Cases with incorrect code assignment were less morbid than cases with correct code assignment, with a lower incidence of hysterectomy at delivery (17% vs 100%), blood transfusion (26% vs 75%) and admission to the intensive care unit (0% vs 53%). Primary reasons for code misassignment included code assigned to cases of occult placenta accreta (35%) or to cases with clinical evidence of placental adherence without histopatholic diagnostic (35%) features.
These findings from a quaternary obstetric centre suggest that ICD-10 codes may be useful for research and surveillance of placenta accreta spectrum, but researchers should be aware of likely substantial false positive cases.
《国际疾病分类》第 10 次修订版（ICD-10）首次纳入了胎盘植入谱系疾病的诊断编码。这些编码可以为胎盘植入谱系疾病的有价值的研究和监测提供便利，因为这种疾病是一种危及生命的妊娠并发症，其发病率正在上升。
我们旨在评估 ICD-10 中引入的胎盘植入谱系疾病诊断编码的有效性，并评估导致编码错误的因素。
我们在一家四级产科中心回顾了 2015 年 10 月至 2020 年 3 月的病历，计算了 ICD-10 胎盘植入谱系疾病编码分配的敏感性、特异性、阳性预测值和阴性预测值。组织病理学诊断被认为是金标准。
在 22345 名患者中，有 104 名（0.46%）患者有 ICD-10 胎盘植入谱系疾病编码，51 名（0.23%）患者有组织病理学诊断。ICD-10 编码的敏感性为 0.71（95%CI 0.56，0.83），特异性为 0.98（95%CI 0.93，1.00），阳性预测值为 0.61（95%CI 0.48，0.72），阴性预测值为 1.00（95%CI 0.96，1.00）。ICD-10 胎盘植入谱系疾病亚型（粘连性、植入性和穿透性）的编码敏感性分别为 0.55（95%CI 0.31，0.78）、0.33（95%CI 0.12，0.62）和 0.56（95%CI 0.31，0.78）。编码错误分配的病例比正确分配的病例病情较轻，分娩时子宫切除的发生率较低（17%比 100%），输血的发生率较低（26%比 75%），入住重症监护病房的发生率较低（0%比 53%）。编码错误分配的主要原因包括将编码分配给隐匿性胎盘植入病例（35%）或具有胎盘粘连临床证据但无组织病理学诊断特征的病例（35%）。
这项来自四级产科中心的研究结果表明，ICD-10 编码可能对胎盘植入谱系疾病的研究和监测有用，但研究人员应该意识到可能存在大量的假阳性病例。
