■肠道感染及其慢性后遗症是导致残疾和死亡的主要原因。尽管越来越多地使用行政卫生数据来衡量人口的慢性病负担,缺乏经过验证的基于代码的国际疾病分类(ICD)病例定义,特别是在加拿大的背景下。我们的目的是验证加拿大肠道感染后遗症的ICD代码定义:急性肾损伤(AKI);溶血性尿毒综合征(HUS);血栓性血小板减少性紫癜(TTP);格林-巴利综合征/米勒-费希尔综合征(GBS/MFS);慢性炎症性脱髓鞘性多发性神经病(CIDP);强直性脊柱炎(AS);反应性关节炎;溃疡性结肠炎,乳糜泻,结节性红斑(EN);新生儿李斯特菌病(NL);和Graves病(GD)。
■我们使用了多步骤的方法,通过进行文献综述来识别现有的有效定义,临床医生对已验证的定义进行评估,进行图表审查以验证建议的定义和最终的临床医生审查。我们测量了建议定义的敏感性和阳性预测值(PPV)。
■40项研究符合纳入标准。我们确定了12个后遗症的验证定义;临床医生开发了三个(EN,NL,GD)。我们回顾了6例后遗症的181张图表(AKI,HUS,TTP,GBS/MFS,CIDP,AS).ICD代码定义的灵敏度(42.8%-100%)和PPV(63.6%-100%)各不相同。临床医生在图表审查后修改了六个定义(AKI,TTP,GBS/MFS,CIDP,AS,反应性关节炎)以反映编码实践,增加特异性或灵敏度,并解决后勤限制。
■推导ICD代码定义的多步骤设计提供了识别现有定义的灵活性,提高他们的敏感度和PPV,并使他们适应加拿大的环境。
UNASSIGNED: Enteric infections and their chronic sequelae are a major cause of disability and death. Despite the increasing use of administrative health data in measuring the burden of chronic diseases in the population, there is a lack of validated International Classification of Disease (ICD) code-based case definitions, particularly in the Canadian context. Our objective was to validate ICD code definitions for sequelae of enteric infections in Canada: acute kidney injury (AKI); hemolytic uremic syndrome (HUS); thrombotic thrombocytopenic purpura (TTP); Guillain-Barré syndrome/Miller-Fisher syndrome (GBS/MFS); chronic inflammatory demyelinating polyneuropathy (CIDP); ankylosing spondylitis (AS); reactive arthritis; anterior uveitis; Crohn\'s disease, ulcerative colitis, celiac disease, erythema nodosum (EN); neonatal listeriosis (NL); and Graves\' disease (GD).
UNASSIGNED: We used a multi-step approach by conducting a literature review to identify existing validated definitions, a clinician assessment of the validated definitions, a chart review to verify proposed definitions and a final clinician review. We measured the sensitivity and positive predictive value (PPV) of proposed definitions.
UNASSIGNED: Forty studies met inclusion criteria. We identified validated definitions for 12 sequelae; clinicians developed three (EN, NL, GD). We reviewed 181 charts for 6 sequelae (AKI, HUS, TTP, GBS/MFS, CIDP, AS). Sensitivity (42.8%-100%) and PPV (63.6%-100%) of ICD code definitions varied. Six definitions were modified by clinicians following the chart review (AKI, TTP, GBS/MFS, CIDP, AS, reactive arthritis) to reflect coding practices, increase specificity or sensitivity, and address logistical constraints.
UNASSIGNED: The multi-step design to derive ICD code definitions provided flexibility to identify existing definitions, to improve their sensitivity and PPV and adapt them to the Canadian context.