Lemus Hernan Nicolas, Goldstein Jonathan, Tai Hua-Hsin, Lin Jung-Yi, Kwon Churl-Su, Agarwal Parul, Kummer Benjamin, Dhamoon Mandip, Mathews Kusum, Nirenberg Sharon, Jetté Nathalie, Blank Leah J
Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Epilepsia. 2025 May 3. doi: 10.1111/epi.18446.
Electronic health records (EHRs) are increasingly used to conduct research and evaluate epilepsy quality of care. We examined the accuracy of International Classification of Diseases, 9th and 10th Revision, Clinical Modification (ICD-9-CM, ICD-10-CM)- and antiseizure medicine (ASM)-based algorithms for adult epilepsy.
Data from a diverse New York multicenter EHR were queried to identify encounters between January 1, 2012 and September 20, 2018 coded with an epilepsy/seizure ICD-CM code or an ASM. Eight hundred adults were randomly selected (350 with epilepsy-related codes, 150 with an ASM, and 300 with drug-resistant epilepsy codes). With chart review defined as the reference standard, sensitivity (Sn), specificity (Sp), negative predictive value (NPV), positive predictive value (PPV), and Youden index (YI) were calculated to evaluate various ICD-9-CM-, ICD-10-CM-, ± ASM-based algorithms' accuracy in predicting epilepsy.
Ninety-four algorithms were tested. A total of 435 (54.4%) patients had definite epilepsy. Estimates ranged as follows: YI = .18-.68, Sn = .59-.95, Sp = .52-.97, PPV = .67-.92, and NPV = .51-.93. The best algorithms were as follows. Highest YI for ICD-9-CM was single encounter with 345 (except 345.2 or 345.3) or 345.2, 345.3, or 780.3 with an ASM (Sn = .95, Sp = .73, PPV = .81, NPV = .92, YI = .68). Highest Y1 for ICD-10-CM was one encounter with G40 in primary diagnostic position or ≥2 encounters with G40 in any diagnostic position (Sn = .82, Sp = .85, PPV = .87, NPV = .80, YI = .67). Highest sensitivity was any encounter with ICD-9-CM 345 or 780.39 or ICD-10-CM G40, G41, or R56.9 (Sn = .96, Sp = .57, PPV = .73, NPV = .93, YI = .53). Highest specificity was ≥1 hospitalization with ICD-9-CM 345.x (except 345.2 and 345.3) or ICD-10-CM G40.x (Sn = .21, Sp = .97, PPV = .89, NPV = .51, YI = .18).
We identified ICD-9/10-CM-based case definitions (with and without ASM) that were sensitive and specific for epilepsy. Ultimately, extensive algorithms are provided to help inform case definition selection according to future study aims.
电子健康记录（EHRs）越来越多地用于开展研究和评估癫痫护理质量。我们检验了基于国际疾病分类第9版和第10版临床修订本（ICD-9-CM、ICD-10-CM）以及抗癫痫药物（ASM）的算法对成人癫痫的准确性。
查询来自纽约一个多元化多中心电子健康记录的数据，以识别2012年1月1日至2018年9月20日期间使用癫痫/发作ICD-CM编码或抗癫痫药物编码的就诊情况。随机选择了800名成年人（350名有癫痫相关编码，150名使用抗癫痫药物，300名有耐药性癫痫编码）。以病历审查作为参考标准，计算敏感性（Sn）、特异性（Sp）、阴性预测值（NPV）、阳性预测值（PPV）和尤登指数（YI），以评估各种基于ICD-9-CM、ICD-10-CM、±抗癫痫药物的算法在预测癫痫方面的准确性。
测试了94种算法。共有435名（54.4%）患者患有明确的癫痫。估计范围如下：YI = 0.18 - 0.68，Sn = 0.59 - 0.95，Sp = 0.52 - 0.97，PPV = 0.67 - 0.92，NPV = 0.51 - 0.93。最佳算法如下。ICD-9-CM的最高YI是单次就诊时使用345（345.2或345.3除外）或345.2、345.3或780.3并使用抗癫痫药物（Sn = 0.95，Sp = 0.73，PPV = 0.81，NPV = 0.92，YI = 0.68）。ICD-10-CM的最高Y1是在主要诊断位置单次遇到G40或在任何诊断位置遇到≥2次G40（Sn = 0.82，Sp = 0.85，PPV = 0.87，NPV = 0.80，YI = 0.67）。最高敏感性是单次遇到ICD-9-CM 345或780.39或ICD-10-CM G40、G41或R56.9（Sn = 0.96，Sp = 0.57，PPV = 0.73，NPV = 0.93，YI = 0.53）。最高特异性是使用ICD-9-CM 345.x（345.2和345.3除外）或ICD-10-CM G40.x至少住院1次（Sn = 0.21，Sp = 0.97，PPV = 0.89，NPV = 0.51，YI = 0.18）。
我们确定了基于ICD-9/10-CM的病例定义（有或无抗癫痫药物）对癫痫具有敏感性和特异性。最终，提供了广泛的算法，以根据未来的研究目的帮助选择病例定义。
