仅使用国际疾病分类代码可能会对围产期人群的药物过量情况进行错误分类。
Using ICD Codes Alone May Misclassify Overdoses Among Perinatal People.
作者信息
Board Amy, Vivolo-Kantor Alana, Kim Shin Y, Tran Emmy L, Thomas Shawn A, Terplan Mishka, Smid Marcela C, Sanjuan Pilar M, Wright Tanner, Davidson Autumn, Wachman Elisha M, Rood Kara M, Morse Diane, Chu Emily, Miele Kathryn
机构信息
Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
出版信息
Am J Prev Med. 2025 Mar;68(3):563-570. doi: 10.1016/j.amepre.2024.12.001. Epub 2024 Dec 5.
INTRODUCTION
As perinatal drug overdoses continue to rise, reliable approaches are needed to monitor overdose trends during pregnancy and postpartum. This analysis aimed to determine the sensitivity, specificity, positive predictive value, and negative predictive value of ICD-9/10-CM codes for drug overdose events among people in the MATernaL and Infant clinical NetworK (MAT-LINK) with medication for opioid use disorder during pregnancy.
METHODS
People included in this analysis had electronic health record documentation of medication for opioid use disorder and a known pregnancy outcome from January 1, 2014, through August 31, 2021. Data were analyzed during pregnancy through 1 year postpartum. The Centers for Disease Control and Prevention's drug overdose case definitions were used to categorize overdose based on ICD-9/10-CM codes. These codes were compared to abstracted electronic health record data of any drug overdose. Analyses were conducted between May 2023 and May 2024.
RESULTS
Among 3,911 pregnancies with electronic health record-documented medication for opioid use disorder, the sensitivity of ICD-9/10-CM codes for capturing drug overdose during pregnancy was 32.7%, while specificity was 98.5%, positive predictive value was 23.4%, and negative predictive value was 99.0%. The sensitivity of ICD-9/10-CM codes for capturing drug overdose postpartum was 30.9%, while specificity was 98.4%, positive predictive value was 25.9%, and negative predictive value was 98.8%.
CONCLUSIONS
The sensitivity and positive predictive value of ICD-9/10-CM codes for capturing drug overdose compared with abstracted electronic health record data during the perinatal period was low in this cohort of people with medication for opioid use disorder during pregnancy, though the specificity and negative predictive value were high. Incorporating other data from electronic health records and outside the healthcare system might provide more comprehensive insights on nonfatal drug overdose in this population.
引言
随着围产期药物过量服用情况持续增加，需要可靠的方法来监测孕期和产后的药物过量服用趋势。本分析旨在确定母婴临床网络（MAT-LINK）中孕期使用阿片类药物使用障碍药物的人群中，国际疾病分类第九版/第十版临床修正版（ICD-9/10-CM）编码对药物过量事件的敏感性、特异性、阳性预测值和阴性预测值。
方法
纳入本分析的人群在2014年1月1日至2021年8月31日期间有阿片类药物使用障碍药物的电子健康记录文档以及已知的妊娠结局。对孕期至产后1年的数据进行分析。疾病控制与预防中心的药物过量病例定义用于根据ICD-9/10-CM编码对药物过量进行分类。将这些编码与任何药物过量的电子健康记录摘要数据进行比较。分析在2023年5月至2024年5月期间进行。
结果
在3911例有电子健康记录记录的孕期使用阿片类药物使用障碍药物的妊娠中，ICD-9/10-CM编码捕捉孕期药物过量的敏感性为32.7%，特异性为98.5%，阳性预测值为23.4%，阴性预测值为99.0%。ICD-9/10-CM编码捕捉产后药物过量的敏感性为30.9%，特异性为98.4%，阳性预测值为25.9%，阴性预测值为98.8%。
结论
在这一孕期使用阿片类药物使用障碍药物的人群队列中，与电子健康记录摘要数据相比，ICD-9/10-CM编码捕捉围产期药物过量的敏感性和阳性预测值较低，尽管特异性和阴性预测值较高。纳入电子健康记录和医疗系统之外的其他数据可能会为该人群中非致命药物过量提供更全面的见解。
Zotero 插件