From the Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
Emory University School of Medicine, Atlanta, GA.
Epidemiology. 2024 Jul 1;35(4):506-511. doi: 10.1097/EDE.0000000000001743. Epub 2024 Mar 29.
Severe maternal morbidity is a composite measure of serious obstetric complications that is often identified in administrative data using the International Classification of Diseases (ICD) diagnosis and procedure codes for a set of 21 indicators. Prior studies of screen-positive cases have demonstrated low predictive value for ICD codes relative to the medical record. To our knowledge, the validity of ICD-10 codes for identifying severe maternal morbidity has not been fully described.
We estimated the sensitivity, specificity, positive predictive value, and negative predictive value of ICD-10 codes for severe maternal morbidity occurring at delivery, compared with medical record abstraction (gold standard), for 1,000 deliveries that took place during 2016-2018 at a large, public hospital.
We identified a total of 67 cases of severe maternal morbidity using the ICD-10 definition and 74 cases in the medical record. The sensitivity was 26% (95% confidence interval [CI] = 16%, 37%), the positive predictive value was 28% (95% CI = 18%, 41%), the specificity was 95% (95% CI = 93%, 96%), and the negative predictive value was 94% (95% CI = 92%, 96%).
The validity of ICD-10 codes for severe maternal morbidity in our high-burden population was poor, suggesting considerable potential for bias.
严重产妇发病率是一种严重产科并发症的综合衡量标准，通常通过国际疾病分类（ICD）诊断和程序代码在行政数据中识别出 21 个指标。之前对筛查阳性病例的研究表明，与病历相比，ICD 代码对预测值的准确性较低。据我们所知，ICD-10 代码用于识别严重产妇发病率的有效性尚未得到充分描述。
我们在一家大型公立医院 2016 年至 2018 年期间的 1000 次分娩中，比较了 ICD-10 编码（黄金标准）与病历摘录，估计了用于识别分娩时发生的严重产妇发病率的 ICD-10 编码的敏感性、特异性、阳性预测值和阴性预测值。
我们使用 ICD-10 定义共确定了 67 例严重产妇发病率病例，在病历中确定了 74 例。敏感性为 26%（95%置信区间[CI] = 16%，37%），阳性预测值为 28%（95%CI = 18%，41%），特异性为 95%（95%CI = 93%，96%），阴性预测值为 94%（95%CI = 92%，96%）。
在我们高负担人群中，ICD-10 编码严重产妇发病率的有效性较差，表明存在相当大的偏倚可能性。
