目的:概述各种败血症国际疾病分类(ICD)编码方法及其诊断准确性。
方法:我们在1991年至2020年之间进行了系统的范围审查(搜索词:脓毒症,编码,和流行病学),包括报告脓毒症ICD编码方法准确性的研究。研究按ICD编码方法分组,诊断准确性参数的数量,ICD版本,参考标准,设计,国家,设置,数据集类型和败血症定义。ICD编码方法分为显式或隐式,与明确的方法进一步分为宽的和窄的组。描述性统计用于提供数据。
结果:我们分析了17项研究,其中16人(94.1%)使用回顾性医学图表审查作为临床败血症的参考标准,8人(47.1%)使用医院管理数据来识别脓毒症.对各种ICD编码方法进行了53次评估,其中32种(60.4%)是显式方法,21种(39.6%)是隐式方法。编码方法的灵敏度中位数<75%,但特异性中位数>85%。然而,所有ICD编码方法的诊断准确性参数差异很大.大多数研究显示出较高的方法学质量。
结论:目前的ICD编码方法都不是鉴别脓毒症的最佳方法。
OBJECTIVE: To provide an overview of various sepsis International Classification of Diseases (ICD) coding methods and their diagnostic accuracy.
METHODS: We undertook a systematic scoping
review between 1991 and 2020 (search terms: sepsis, coding, and epidemiology) to include studies reporting the accuracy of a sepsis ICD coding method. Studies were grouped by ICD coding method, number of diagnostic accuracy parameters, ICD version, reference standard, design, country, setting, type of dataset and sepsis definition. ICD coding methods were categorised as explicit or implicit, with the explicit methods further divided into wide and narrow groups. Descriptive statistics were used to present data.
RESULTS: We analysed 17 studies, of which 16 (94.1%) used retrospective medical chart
review as the reference standard for clinical sepsis, and eight (47.1%) used hospital administrative data to identify sepsis. There were 53 assessments of various ICD coding methods, with 32 (60.4%) of them being explicit and 21 (39.6%) implicit methods. The coding methods had a median sensitivity of <75% but a median specificity of >85%. However, a wide variation was noted in the diagnostic accuracy parameters of all ICD coding methods. Most of the studies showed high methodological quality.
CONCLUSIONS: None of the current ICD coding methods is optimal for identifying sepsis.