Sensitivity Of Diagnostic Codes Research Articles

Validation of administrative database codes for acute kidney injury in kidney transplant recipients.

BackgroundValidation studies of acute kidney injury (AKI) diagnostic codes performed in the general population have shown poor sensitivity, but the accuracy of such codes in the kidney transplant population remains unknown.ObjectiveThe objective of this study is to determine the accuracy of AKI diagnostic codes in kidney transplant recipients. We hypothesized that the sensitivity of diagnostic codes would be significantly greater in the kidney transplant population since these patients are closely followed by nephrologists and are more likely to have serum creatinine measured.DesignThe design is a population-based retrospective cohort study using healthcare administrative and laboratory databases.SettingThe setting is in Southwestern Ontario and Ottawa, Ontario, Canada, from 2003 to 2012.PatientsWe included first-time kidney transplant recipients admitted to hospital for whom serum creatinine was measured in hospital and within 6 months prior (n = 524).MethodsPatients meeting the Acute Kidney Injury Network (AKIN) classification serum creatinine change criteria were classified as having AKI. We determined the sensitivity, specificity, and negative and positive predictive values for the ICD-10-CA code for AKI when present as an admission diagnosis, most responsible diagnosis, or any diagnosis compared to a reference standard of AKI defined by the AKIN criteria (stage 1 or greater, stage 2 or greater, or stage 3).ResultsForty-five percent of included kidney transplant patients had a diagnosis of AKI. The most sensitive coding algorithm (reference standard AKIN stage 2 or greater, ICD-10 code present as any diagnosis) had a sensitivity of 42.1 % (95 % CI 31.7, 53.3), a specificity of 90.6 % (95 % CI 87.6, 93.0), and a positive likelihood ratio of 4.5. The median (IQR) rise in serum creatinine from baseline in patients with and without AKI codes was 104 (57 to 158) μmol/L and 16 (−3 to 41) μmol/L, respectively (Mann-Whitney test, p < 0.0001).LimitationsThe low sensitivity of the AKI code may be due to an alternative diagnosis of acute rejection being assigned in certain cases. The cause of AKI could not be determined.ConclusionsSimilar to the general population, the ICD-10 N17x code misses many kidney transplant patients with AKI during their hospitalization. This makes the code unusable for studying the incidence and consequences of AKI in hospitalized kidney transplant patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s40697-016-0108-7) contains supplementary material, which is available to authorized users.

Validity of ICD-9-CM Administrative Data for Determining Eligibility for Pneumococcal Vaccination Triggers

The purpose of this study was to evaluate the efficacy of medical record administrative data as coded by the International Classification of Diseases, Ninth Revision, for triggering pneumococcal vaccination reminders of patients following discharge from a tertiary care adult teaching hospital. A retrospective computerized search was conducted using administrative discharge data to detect patients admitted to the medical teaching unit who met clinical criteria for pneumococcal vaccination according to Canadian immunization guidelines. For identification of persons eligible for vaccination, administrative discharge data showed a sensitivity of 83% (confidence interval [CI], 0.73-0.92) and a specificity of 78% (CI, 0.64-0.91), with a positive predictive value of 87% (CI, 0.83-0.90) and a negative predictive value of 72% (CI, 0.58-0.86). The reasonably high specificity and sensitivity of diagnostic codes in administrative data could be used to trigger appropriate pneumococcal vaccination among eligible patients after hospital discharge.