Validating International Classification of Diseases Code 10th Revision algorithms for accurate identification of pulmonary embolism.

Autor:	Bikdeli B; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; YNHH/Yale Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA. Electronic address: Behnood.bikdeli@yale.edu., Khairani CD; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Bejjani A; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Lo YC; Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Mahajan S; YNHH/Yale Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA., Caraballo C; YNHH/Yale Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA., Jimenez JV; YNHH/Yale Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA., Krishnathasan D; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Zarghami M; Division of Allergy and Clinical Immunology and Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Rashedi S; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Jimenez D; Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain., Barco S; Department of Angiology, University Hospital Zurich, Zurich, Switzerland; Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany., Secemsky EA; Department of Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA., Klok FA; Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands., Hunsaker AR; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Aghayev A; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Muriel A; Biostatistics Department, Hospital Ramón y Cajal, and Universidad de Alcalá, Madrid, Spain; CIBER de Epidemiología y Salud Pública, Madrid, Spain., Hussain MA; Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA., Appah-Sampong A; Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA., Lu Y; YNHH/Yale Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA., Lin Z; YNHH/Yale Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA., Mojibian H; Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA., Aneja S; YNHH/Yale Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, USA., Khera R; YNHH/Yale Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA., Konstantinides S; Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece., Goldhaber SZ; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Wang L; Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Zhou L; Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Monreal M; Cátedra de Enfermedad Tromboembólica, Universidad Católica de Murcia, Murcia, Spain., Piazza G; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Krumholz HM; YNHH/Yale Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.
Jazyk:	angličtina
Zdroj:	Journal of thrombosis and haemostasis : JTH [J Thromb Haemost] 2024 Nov 04. Date of Electronic Publication: 2024 Nov 04.
DOI:	10.1016/j.jtha.2024.10.013
Abstrakt:	Background: Many research investigations for pulmonary embolism (PE) rely on the International Classification of Diseases 10th Revision (ICD-10) codes for analyses of electronic databases. The validity of ICD-10 codes in identifying PE remains uncertain. Objectives: The objective of this study was to validate an algorithm to efficiently identify pulmonary embolism using ICD-10 codes. Methods: Using a prespecified protocol, patients in the Mass General-Brigham hospitals (2016-2021) with ICD-10 principal discharge codes for PE, those with secondary codes for PE, and those without PE codes were identified (n = 578 from each group). Weighting was applied to represent each group proportionate to their true prevalence. The accuracy of ICD-10 codes for identifying PE was compared with adjudication by independent physicians. The F1 score, which incorporates sensitivity and positive predictive value (PPV), was assessed. Subset validation was performed at Yale-New Haven Health System. Results: A total of 1712 patients were included (age: 60.6 years; 52.3% female). ICD-10 PE codes in the principal discharge position had sensitivity and PPV of 58.3% and 92.1%, respectively. Adding secondary discharge codes to the principal discharge codes improved the sensitivity to 83.2%, but the PPV was reduced to 79.1%. Using a combination of ICD-10 PE principal discharge codes or secondary codes plus imaging codes for PE led to sensitivity and PPV of 81.6% and 84.7%, respectively, and the highest F1 score (83.1%; P < .001 compared with other methods). Validation yielded largely similar results. Conclusion: Although the principal discharge codes for PE show excellent PPV, they miss 40% of acute PEs. A combination of principal discharge codes and secondary codes plus PE imaging codes led to improved sensitivity without severe reduction in PPV. Competing Interests: Declaration of competing interests Outside the submitted work, B.B. was supported by the Scott Schoen and Nancy Adams IGNITE Award and is supported by the Mary Ann Tynan Research Scientist award from the Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital and the Heart and Vascular Center Junior Faculty Award from Brigham and Women’s Hospital. B.B. reports that he was a consulting expert on behalf of the plaintiff for litigation related to 2 specific brand models of inferior vena cava filters. B.B. has not been involved in the litigation from 2022 to 2024, nor has he received any compensation from 2022 to 2024. B.B. reports that he is a member of the Medical Advisory Board for the North American Thrombosis Forum and serves in the Data Safety and Monitory Board of the NAIL-IT trial funded by the National Heart, Lung, and Blood Institute and Translational Sciences. B.B. is a collaborating consultant with the International Consulting Associates and the US Food and Drug Administration in a study to generate knowledge about the utilization, predictors, retrieval, and safety of inferior vena cava filters. B.B. receives compensation as an Associated Editor for the New England Journal of Medicine Journal Watch Cardiology, as an Associate Editor for Thrombosis Research, and as an Executive Associate Editor for JACC, and is a Section Editor for Thrombosis and Haemostasis (no compensation). E.A.S. receives funding from NIH/National Heart, Lung, and Blood Institute K23HL150290, Food & Drug Administration, and SCAI. G.P. received research grants from Abbott/CSI, BD, Boston Scientific, Cook, Medtronic, and Philips. E.A.S. reports to the consulting/speakers board for Abbott/CSI, BD, BMS, Boston Scientific, Cagent, Conavi, Cook, Cordis, Endovascular Engineering, Gore, InfraRedx, Medtronic, Philips, RapidAI, Rampart, Shockwave, Siemens, Terumo, Thrombolex, VentureMed, and Zoll. G.P. received research grants from BMS/Pfizer, Janssen, Alexion, Bayer, Amgen, BSC, Esperion, and 1R01HL164717-01. G.P. reports an advisory role for BSC, Amgen, BCRI, PERC, NAMSA, BMS, Janssen, and Regeneron. A.B. would like to acknowledge the training received under the Scholars in HeAlth Research Program (SHARP) that was in part supported by the Fogarty International Center and Office of Dietary Supplements of the National Institutes of Health (Award Number D43 TW009118). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The other authors have no conflicts of interest to disclose. (Copyright © 2024 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)
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