ICD-10 诊断编码用于胎盘植入谱系疾病的有效性。
Validity of ICD-10 diagnosis codes for placenta accreta spectrum disorders.
机构信息
Department of Obstetrics and Gynecology, Stanford University, Stanford, California, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA.
出版信息
Paediatr Perinat Epidemiol. 2024 Jul;38(5):435-439. doi: 10.1111/ppe.13076. Epub 2024 Mar 21.
BACKGROUND
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.
OBJECTIVE
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
背景
《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。
目的
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。
方法
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。
结果
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%）。
结论
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。
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