Lozano Álvarez Marcos, Moya Garcés Alba, Imaz Goienetxea Liher, Lameiras Azevedo Ana Sofía, Otero Barros María Teresa, Ruiz de Porras Rubio Carlota, Latasa Zamalloa Pello, López Torrijos Miriam, Corpas Burgos Francisca, Marques Diogo, Sánchez Ruiz Miguel Ángel, Pérez Martínez Olaia, Monge Susana
Centro Nacional de Epidemiología. Instituto de Salud Carlos III. Madrid. España.
Escuela Internacional de Doctorado de la UNED. Madrid. España.
Rev Esp Salud Publica. 2025 May 21;99:e202505025.
ICD-10 diagnostic codes could be useful for automated surveillance of Severe Acute Respiratory Infection (SARI). This study analyzed the validity of different SARI case definitions (CD) based on ICD-10 codes at hospital discharge in Catalonia, the Valencian Community, Galicia and the Basque Country between weeks 21/2021 and 39/2023.
Patients with respiratory system codes (J00 to J99, R06, U07) and with a laboratory test performed were included, with the gold standard being positivity to the corresponding pathogen. The validity of all possible combinations of ICD-10 codes was estimated, prioritizing the CDs according to the average sensitivity (Se) and specificity (Sp). Validity was estimated by age groups, but expert criteria were used to seek the optimal CD, unique for each pathogen, balancing validity and simplicity.
The CD selected for influenza for any age included the specific codes J09.X, J10.0, J10.1, J10.2, J10.8 and J11 (Se=95.4; Sp=99.7), and for SARS-CoV-2, codes U07.1 and J12.8 (Se=95.9; Sp=98.3). For RSV, validity was lower, with significant heterogeneity by age and inclusion of non-specific codes. The optimal CD included codes J06, J12.1, J13, J20.5, J21.0 and J45 (Se=63.9; Sp=88.4), recommending adding J98 for adults and when it is important to maximize Se (Se=88.9; Sp=65.3). The overall CD for the three viruses was consistent with the specific CDs.
The ICD-10 codes provides great validity in identifying influenza and SARS-CoV-2 hospitalizations, but shows poorer performance and greater age-group variability for RSV.
国际疾病分类第十版（ICD - 10）诊断编码可能有助于对严重急性呼吸道感染（SARI）进行自动监测。本研究分析了2021年第21周和2023年第39周期间，加泰罗尼亚、巴伦西亚自治区、加利西亚和巴斯克地区基于ICD - 10编码在医院出院时不同SARI病例定义（CD）的有效性。
纳入具有呼吸系统编码（J00至J99、R06、U07）且进行了实验室检测的患者，金标准为相应病原体呈阳性。估计了ICD - 10编码所有可能组合的有效性，并根据平均敏感性（Se）和特异性（Sp）对病例定义进行排序。按年龄组估计有效性，但使用专家标准来寻找针对每种病原体的最佳病例定义，在有效性和简单性之间取得平衡。
为任何年龄的流感选择的病例定义包括特定编码J09.X、J10.0、J10.1、J10.2、J10.8和J11（Se = 95.4；Sp = 99.7），对于严重急性呼吸综合征冠状病毒2（SARS-CoV-2），编码为U07.1和J12.8（Se = 95.9；Sp = 98.3）。对于呼吸道合胞病毒（RSV），有效性较低，不同年龄存在显著异质性且包含非特异性编码。最佳病例定义包括编码J06、J12.1、J13、J20.5、J21.0和J45（Se = 63.9；Sp = 88.4），建议在针对成人以及最大化敏感性很重要时添加J98（Se = 88.9；Sp = 65.3）。三种病毒的总体病例定义与特定病例定义一致。
ICD - 10编码在识别流感和SARS-CoV-2住院病例方面具有很高的有效性，但对于RSV表现较差且年龄组差异较大。
