Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

Autor:	Michael J. Durkin, Linda Jiang, Laura R. Marks, Stephen Y. Liang, Nathanial S Nolan, Dharushana Muthulingam
Jazyk:	angličtina
Rok vydání:	2020
Předmět:	medicine.medical_specialty 01 natural sciences Major Articles 03 medical and health sciences 0302 clinical medicine Syndemic ICD-10 Internal medicine mental disorders Medicine Endocarditis 030212 general & internal medicine 0101 mathematics medications for opioid use disorder business.industry 010102 general mathematics Opioid use disorder opioid use disorder medicine.disease Infectious Diseases AcademicSubjects/MED00290 Oncology Infective endocarditis Relative risk Cohort endocarditis Diagnosis code business persons who inject drugs
Zdroj:	Open Forum Infectious Diseases
ISSN:	2328-8957
Popis:	Background No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use–associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. Results ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48–2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19–1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (P = .007). Conclusions Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed.
Databáze:	OpenAIRE
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