Benesch C, Witter D M, Wilder A L, Duncan P W, Samsa G P, Matchar D B
Department of Neurology, University of Rochester School of Medicine, NY, USA.
Neurology. 1997 Sep;49(3):660-4. doi: 10.1212/wnl.49.3.660.
In administrative databases the International Classification of Diseases, Version 9, Clinical Modification (ICD-9-CM) is often used to identify patients with specific diagnoses. However, certain conditions may not be accurately reflected by the ICD-9 codes. We assessed the accuracy of ICD-9 coding for cerebrovascular disease by comparing ICD-9 codes in an administrative database with clinical findings ascertained from medical record abstractions. We selected patients with ICD-9 diagnostic codes of 433 through 436 (in either the primary or secondary positions) from an administrative database of patients hospitalized in five academic medical centers in 1992. Medical records of the selected patients were reviewed by trained medical abstractors, and the patients' clinical conditions during the admission (stroke, TIA, asymptomatic) were recorded, as well as any history of cerebrovascular symptoms. Results of the medical record review were compared with the ICD-9 codes from the administrative database. More than 85% of those patients with the ICD-9 code 433 were asymptomatic for the index admission. More than one-third of these asymptomatic patients did not undergo either cerebral angiography or carotid endarterectomy. For ICD-9 code 434, 85% of patients were classified as having a stroke and for ICD-9 code 435, 77% had TIAs. For code 436, 77% of patients were classified as having strokes. Limiting the identifying ICD-9 code to the primary position increased the likelihood of agreement with the medical record review. The ICD-9 coding scheme may be inaccurate in the classification of patients with ischemic cerebrovascular disease. Its limitations must be recognized in the analyses of administrative databases selected by using ICD-9 codes 433 through 436.
在管理数据库中，国际疾病分类第9版临床修订本（ICD - 9 - CM）常被用于识别患有特定诊断的患者。然而，某些病症可能无法通过ICD - 9编码准确反映。我们通过比较管理数据库中的ICD - 9编码与病历摘要确定的临床发现，评估了ICD - 9编码对脑血管疾病的准确性。我们从1992年在五个学术医疗中心住院患者的管理数据库中，选取了ICD - 9诊断编码为433至436（主要或次要位置）的患者。经过培训的医学摘要员审查了所选患者的病历，并记录了患者入院期间的临床状况（中风、短暂性脑缺血发作、无症状）以及任何脑血管症状史。将病历审查结果与管理数据库中的ICD - 9编码进行比较。ICD - 9编码为433的患者中，超过85%在本次入院时无症状。这些无症状患者中有超过三分之一未接受脑血管造影或颈动脉内膜切除术。对于ICD - 9编码434，85%的患者被归类为患有中风；对于ICD - 9编码435，77%的患者有短暂性脑缺血发作；对于编码436，77%的患者被归类为患有中风。将识别ICD - 9编码限制在主要位置增加了与病历审查一致的可能性。ICD - 9编码方案在缺血性脑血管疾病患者的分类中可能不准确。在使用ICD - 9编码433至436选择的管理数据库分析中，必须认识到其局限性。
