基于国际疾病分类（ICD）-10编码和影像报告的孤立性亚段肺栓塞识别
Isolated subsegmental pulmonary embolism identification based on international classification of diseases (ICD)-10 codes and imaging reports.
作者信息
Rashedi Sina, Bejjani Antoine, Hunsaker Andetta R, Aghayev Ayaz, Khairani Candrika D, McGonagle Bridget, Lo Ying-Chih, Mahajan Shiwani, Caraballo César, Jimenez Jose Victor, Krishnathasan Darsiya, Zarghami Mehrdad, Monreal Manuel, Barco Stefano, Secemsky Eric A, Klok Frederikus A, Muriel Alfonso, Hussain Mohamad A, Appah-Sampong Abena, Rahaghi Farbod N, Sadeghipour Parham, Lin Zhenqiu, Mojibian Hamid, Aneja Sanjay, Konstantinides Stavros, Goldhaber Samuel Z, Wang Liqin, Zhou Li, Jimenez David, Krumholz Harlan M, Piazza Gregory, Bikdeli Behnood
机构信息
Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
出版信息
Thromb Res. 2025 Mar;247:109271. doi: 10.1016/j.thromres.2025.109271. Epub 2025 Jan 20.
BACKGROUND
Isolated subsegmental pulmonary embolism (issPE) is a commonly encountered diagnosis. Although the International Classification of Diseases (ICD)-10 codes are used for research, their validity for identifying issPE is unknown. Moreover, issPE diagnosis is challenging, and the findings from radiology reports may conflict with those from expert radiologists.
METHODS
Based on prespecified criteria, 1734 medical records of adult patients hospitalized within the Mass General Brigham health system (2016-2021) were selected in three equal groups: (1) patients with principal discharge diagnosis codes for PE, (2) patients with secondary discharge diagnosis codes for PE, and (3) patients with no PE codes. The accuracy of ICD-10 codes for issPE was verified by two independent physicians and weighted by total hospitalizations. In a randomly selected sample of 70 patients, the accuracy of initial radiology reports was determined through a blinded re-evaluation by two expert radiologists.
RESULTS
In weighted estimates, ICD-10 codes in primary or secondary discharge positions, compared with chart reviews, showed a low sensitivity (7.0 %) and positive predictive value (25.2 %). Evaluation by two expert radiologists noted that initial radiology reports were sensitive (97.1 %) for issPE but had a low specificity (40.0 %). Two (3.6 %) out of 55 patients with initial issPE reports did not have PE, while 19 (34.5 %) had more proximal PE.
CONCLUSIONS
ICD-10 codes for issPE have poor sensitivity and positive predictive value and should not be used for research or quality improvement. Radiology reports for issPE may be inaccurate regarding the location or, less often, the presence of PE.
背景
孤立性亚段肺栓塞（issPE）是一种常见的诊断。虽然国际疾病分类（ICD）-10编码用于研究，但其识别issPE的有效性尚不清楚。此外，issPE的诊断具有挑战性，放射学报告的结果可能与专家放射科医生的结果相冲突。
方法
根据预先设定的标准，在麻省总医院布莱根健康系统（2016 - 2021年）住院的成年患者的1734份病历被分为三组，每组数量相等：（1）主要出院诊断编码为肺栓塞的患者，（2）次要出院诊断编码为肺栓塞的患者，（3）无肺栓塞编码的患者。两名独立医生验证了issPE的ICD-10编码的准确性，并根据总住院人数进行加权。在随机抽取的70例患者样本中，通过两名专家放射科医生的盲法重新评估确定了初始放射学报告的准确性。
结果
在加权估计中，与病历审查相比，主要或次要出院位置的ICD-10编码显示出低敏感性（7.0%）和阳性预测值（25.2%）。两名专家放射科医生的评估指出，初始放射学报告对issPE具有敏感性（97.1%），但特异性较低（40.0%）。55例初始诊断为issPE的患者中有2例（3.6%）没有肺栓塞，而19例（34.5%）有更近端的肺栓塞。
结论
issPE的ICD-10编码敏感性和阳性预测值较差，不应将其用于研究或质量改进。关于issPE的放射学报告在肺栓塞的位置或较少情况下在其存在方面可能不准确。
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