大型电子病历(EMR)数据库可以促进对间质性肺病(ILD)等罕见疾病的流行病学研究。鉴于ILD的稀有性和诊断难度,EMR中编码的有效性需要澄清。我们旨在评估国际疾病分类的有效性,第9版(ICD-9)代码算法,用于识别香港临床数据分析和报告系统(CDARS)的全港电子医疗健康记录系统中的ILD。
使用以下ICD-9代码识别2005-2018年去玛丽医院就诊的ILD患者:炎症后肺纤维化(PPF;ICD-9:515),特发性纤维化肺泡炎(IFA;ICD-9:516.3),结缔组织疾病相关的间质性肺病(CTD-ILD;ICD-9:517.2,517.8,714.81),结节病(ICD-9:135)和外源性过敏性肺泡炎(EAA;ICD-9:495)。在诊断代码为PPF和IFA的情况下,进行了随机选择,发现了相对较高的病例数。所有的CTD-ILD病例,结节病和EAA被包括在相对较小的病例数的验证中。
通过一名呼吸专科医生的病历审查,验证了二百六十九例病例。总体阳性预测值(PPV)为79%(95%CI,74%-84%)。在亚组分析中,PPF的真阳性病例数,IFA,CTD-ILD,结节病和EAA为74/100(74%),95/100(95%),11/15(73%),27/32(84%)和6/22(27%),分别。
这是香港CDARS首次对ILD进行ICD-9编码验证。我们的研究表明,使用ICD-9算法515、516.3、517.2、517.8、714.81和135增强了具有PPV的ILD的识别,这对于支持CDARS数据库用于ILD的进一步临床研究是可靠的。516.3的有效性特别高。
Large electronic medical record (EMR) databases can facilitate epidemiology research into uncommon diseases such as interstitial lung disease (ILD). Given the rarity and diagnostic difficulty of ILD, the validity of the coding in EMR requires clarification. We aimed to assess the validity of International Classification of Diseases, 9th Revision (ICD-9) code algorithms for identifying ILD in the territory-wide electronic medical health record system of Clinical Data Analysis and Reporting System (CDARS) in Hong Kong.
Patients who visited the Queen Mary Hospital in 2005-2018 with ILD were identified using the following ICD-9 codes: post-inflammatory pulmonary fibrosis (PPF; ICD-9: 515), idiopathic fibrosing alveolitis (IFA; ICD-9: 516.3), connective tissue disease-associated interstitial lung disease (CTD-ILD; ICD-9: 517.2, 517.8, 714.81), sarcoidosis (ICD-9: 135) and extrinsic allergic alveolitis (EAA; ICD-9: 495). A random selection was conducted in cases with diagnostic code of PPF and IFA, where a relative higher case number was identified. All the cases of CTD-ILD, sarcoidosis and EAA were included in validation for relatively small case number.
Two hundred and sixty nine cases were validated using medical record review by a respiratory specialist. The overall positive predictive value (PPV) was 79% (95% CI, 74%-84%). In subgroup analysis, true positive case numbers of PPF, IFA, CTD-ILD, sarcoidosis and EAA were 74/100 (74%), 95/100 (95%), 11/15 (73%), 27/32 (84%) and 6/22 (27%), respectively.
This was the first ICD-9 coding validation for ILD in Hong Kong CDARS. Our study demonstrated that using ICD-9 algorithms 515, 516.3, 517.2, 517.8, 714.81 and 135 enhanced identifications of ILDs with PPV that was reliable to support utility of CDARS database for further clinical research on ILDs. The validity is particularly high with 516.3.