用于识别脓毒症的改良全球疾病负担国际疾病分类编码方法的准确性：一项前瞻性多中心队列研究

Accuracy of the modified Global Burden of Disease International Classification of Diseases coding methods for identifying sepsis: a prospective multicentre cohort study.

作者信息

Kumar Ashwani, Venkatesh Bala, Finfer Simon, Delaney Anthony, Thompson Kelly, Middleton Paul M, Aneman Anders, Shetty Kavitha, Bhonagiri Deepak, Saxena Manoj, van Haren Frank M P, Bradford Celia, Reece Graham, Rodda Simon, Mackellar Candice, Bass Francess, Tsang Lewis, Li Sandra, Kwok Raymond, Buckley Alexander, Zou Angela, Sridharan Swathi, Hu David, Iskandar Mark, Frost Sarah, Headington Tori, Connor Giuliana, Klironomos Anthony, Shan Sana, Li Yang, Anderson Belinda, Sidoli Rebecca, Inskip Deborah, Lam Matthew, Fuller Garnette, Yu Christopher, Sigurdson Bridget, McNulty Richard, Sadeghpour Maeda, Billot Laurent, Hammond Naomi

机构信息

The George Institute for Global Health, University of New South Wales, Sydney, Australia.

Princess Alexandra Hospital, Woolloongabba, QLD, Australia.

出版信息

Crit Care. 2025 Jun 2;29(1):218. doi: 10.1186/s13054-025-05448-x.

DOI:10.1186/s13054-025-05448-x

PMID:40457465

Abstract

BACKGROUND

This study assessed the accuracy of three International Classification of Diseases (ICD) codes methods derived from Global Burden of Disease (GBD) sepsis study (modified GBD method) in identifying sepsis, compared to the Angus method. Sources of errors in these methods were also reported.

METHODS

Prospective multicentre, observational, study. Emergency Department patients aged ≥ 16 years with high sepsis risk from nine hospitals in NSW, Australia were screened for clinical sepsis using Sepsis 3 criteria and coded as having sepsis or not using the modified GBD and Angus methods. The three modified GBD methods were: Explicit-sepsis-specific ICD code recorded; Implicit-sepsis-specific code or infection as primary ICD code plus organ dysfunction code; Implicit plus-as for Implicit but infection as primary or secondary ICD code. Agreement between clinical sepsis and ICD coding methods was assessed using Cronbach alpha (α). For false positive cases (ICD-coded sepsis but not clinically diagnosed), the ICD codes leading to those errors were documented. For false negatives (clinically diagnosed sepsis but ICD-coded), uncoded sources of infection and organ dysfunction were documented.

RESULTS

Of 6869 screened patients, 450 (median age 72.4 years, 48.9% females) met inclusion criteria. Clinical sepsis was diagnosed in 215/450 (47.8%). The explicit, implicit, implicit plus and Angus methods identified sepsis in 108/450 (24.0%), 175/450 (38.9%), 222/450 (49.3%) and 170/450 (37.8%), respectively. Sensitivity was 41.4%, 58.1%, 67.4% and 55.8%, and specificity 91.9%, 78.7%, 67.2% and 79.1%, respectively. Agreement between clinical sepsis and all ICD coding methods was low (α = 0.52-0.56). False positives were 19, 50, and 77, while false negatives were 126, 90, and 70 for the explicit, implicit, and implicit plus methods, respectively. For false positive cases, unspecified urinary tract infection, hypotension and acute kidney failure were commonly assigned infection and organ dysfunction codes. About half (44.3%-55.6%) of the false negative cases didn't have a pathogen documented.

CONCLUSION

The modified GBD method demonstrated low accuracy in identifying sepsis; with the implicit plus method being the most accurate. Errors in identifying sepsis using ICD codes arise mostly from coding for unspecified urinary infections and associated organ dysfunction.

TRIAL REGISTRATION

The study was registered at the ANZCTR (ACTRN12621000333819) on 24 March 2021.

摘要

背景

本研究评估了源自全球疾病负担（GBD）脓毒症研究的三种国际疾病分类（ICD）编码方法（改良GBD方法）在识别脓毒症方面的准确性，并与安格斯方法进行了比较。还报告了这些方法中的误差来源。

方法

前瞻性多中心观察性研究。对澳大利亚新南威尔士州九家医院中年龄≥16岁、脓毒症风险高的急诊科患者，使用脓毒症3标准筛查临床脓毒症，并使用改良GBD方法和安格斯方法将其编码为患有脓毒症或未患有脓毒症。三种改良GBD方法分别为：记录明确的脓毒症特异性ICD编码；隐性脓毒症特异性编码或作为主要ICD编码的感染加器官功能障碍编码；隐性加——与隐性方法相同，但感染作为主要或次要ICD编码。使用克朗巴赫α系数（α）评估临床脓毒症与ICD编码方法之间的一致性。对于假阳性病例（ICD编码为脓毒症但未临床诊断），记录导致这些错误的ICD编码。对于假阴性病例（临床诊断为脓毒症但ICD编码未诊断），记录未编码的感染和器官功能障碍来源。

结果

在6869例筛查患者中，450例（中位年龄72.4岁，48.9%为女性）符合纳入标准。215/450例（47.8%）诊断为临床脓毒症。明确、隐性、隐性加和安格斯方法分别在108/450例（24.0%）、175/450例（38.9%）、222/450例（49.3%）和170/450例（37.8%）中识别出脓毒症。敏感性分别为41.4%、58.1%、67.4%和55.8%，特异性分别为91.9%、78.7%、67.2%和79.1%。临床脓毒症与所有ICD编码方法之间的一致性较低（α=0.52 - 0.56）。明确、隐性和隐性加方法的假阳性分别为19例、50例和77例，假阴性分别为126例、90例和70例。对于假阳性病例，未指定的尿路感染、低血压和急性肾衰竭通常被指定感染和器官功能障碍编码。约一半（44.3% - 55.6%）的假阴性病例没有记录病原体。