Recomendação de códigos da CID-10 para vigilância de reações adversas e intoxicações a medicamentos

Abstract

Resumo Propor uma lista-referência de códigos da Classificação Internacional de Doenças e Problemas Relacionados à Saúde (CID-10) para a vigilância de reações adversas e intoxicações a medicamentos, denominados de eventos adversos. A elaboração da lista-referência percorreu quatro fases: definição dos códigos, validação e duas de caracterização da lista. As associações entre variáveis foram avaliadas por qui-quadrado de Pearson e análise de correspondência múltipla. Foram identificados 691 códigos relacionados com reação adversa a medicamentos (52,1%) e intoxicação medicamentosa (47,9%). Um total de 687 (99,4%) e 511 (73,9%) códigos foram validados na 1ª e 2ª validação, respectivamente. Há diferenças estatisticamente significativas (p < 0,05) entre reações adversas e intoxicação medicamentosa nas variáveis utilizadas para a caracterização da lista-referência. A associação entre medicamento e admissão hospitalar e óbito foi estatisticamente significativa quando estratificada por tipo de evento adverso (p < 0,001). Na análise de correspondência múltipla identificou-se três agrupamentos de códigos em que há associações entre as categorias de resposta das variáveis estudadas. A lista-referência pode ser uma ferramenta útil nas ações de farmacovigilância no Brasil.

Hospitalizations and adverse drug events in the Brazilian unified health system: a ten-year retrospective analysis of routine data

“…Differences in frequencies and rates among studies can be partially explained by aspects such as the lack of standardization, especially regarding ADE definitions and ICD coding framework. We defined ADE as “any harm experienced as the result of drug exposure” and included ICD-10 codes of “adverse effects” and “poisoning of unintentional/undetermined cause” previously validated for the Brazilian reality for a wide approach of types of drug harm 11 . Other aspects that can contribute to differences between studies are the structure of the population involved – such as a higher presence of older age groups –, differences in prescribing standards, polypharmacy, as well as differences in documentation and database types 19 , 20 .…”

“…By analyzing codes from the category “certain” only, we found that about 15% of hospitalizations were related to this category. These codes allow identifying a drug as the only one responsible for ADE, excluding confounding factors 11 . A German study, for example, found less cases of hospitalizations related to ADE with codes A1 and B1 (almost half of what we found) 5 .…”

“…Hospitalization data were collected from a period of ten years (2009 to 2018) from SIH-SUS, in which hospitalizations with at least one ICD-10 code related to ADE as primary and/or secondary diagnosis were identified as cases. Cases in this study thus include hospitalization that ends in discharge, death, or change in number of the AIH with the ICD-10 codes predefined 11 . If a unique hospitalization had more than one line, data was gathered in a single line.…”

“…In total, 618 ICD-10 codes were extracted and classified according a list previously validated by Mota et al 11 The classification divides the ICD-10 codes into five categories based on the validity of each one as an indicator of event: Certain (A1 – adverse reaction caused by drug and B1 – poisoning by drugs), Probable (A2 – adverse reaction caused by drug or other causes and B2 – poisoning caused by drug or other causes), Possible (C – adverse event possibly expected by drug), and Occasional (D – adverse event occasionally expected by drug). 11 Supporting information summarizes the codes and categories.…”

“…However, research on ADE using ICD codes varies regarding which codes to use. In Brazil, Mota et al 11 validated a list of codes stratified by groups according to their probability of indicating a real ADE. To our knowledge, however, the list has not been applied to analyze hospitalizations related to ADE.…”