Positive Predictive Value of International Classification of Diseases, 10th Revision, Codes for Cirrhosis and Its Related Complications

Mapakshi, Srikar; Kramer, Jennifer R.; Richardson, Peter; El–Serag, Hashem B.; Kanwal, Fasiha

doi:10.1016/j.cgh.2018.01.042

Cited by 76 publications

(93 citation statements)

References 6 publications

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“…Accurate coding of these is crucial to track patient outcomes, healthcare burden and economic impact of cirrhosis. 10 Similar to findings in VA data, 5 we found that ICD-10-AM codes for ascites, gastrooesophageal varices and HCC were relatively accurate. We also found the probability that patients without these codes didn't have these complications was very high for HCC (97.9%), but substantially lower for ascites (75.8%) and varices (75.5%).…”

Section: Discussionsupporting

confidence: 80%

“…However, internal auditing processes are regularly conducted at a hospital, Health Service and jurisdictional level for quality assurance purposes, which are supported by national data validation activities. As in previous studies, 5 a key limitation is that the patient cohort was identified using a list of ICD-10-AM diagnosis codes for cirrhosis and related complications. Therefore, there was a high prevalence of cirrhosis in the cohort, which impacts PPV and NPV.…”

Section: Discussionmentioning

confidence: 99%

“…Open access which may be influenced by country-specific codes and coding rules, or changes in codes during ICD revisions. 3 The 9th revision of the ICD (ICD-9) and, more recently, selected ICD-10 codes for cirrhosis and related complications have been validated in Department of Veterans Affairs (VA) administrative databases [4][5][6][7] and other US health system databases. 8 9 ICD code lists generated from these studies have formed the basis for case definition of many clinical and epidemiological studies of cirrhosis and its complications.…”

Section: What Are the New Findings?mentioning

confidence: 99%

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ICD-10-AM codes for cirrhosis and related complications: key performance considerations for population and healthcare studies

Hayward¹,

Johnson²,

McKillen³

et al. 2020

BMJ Open Gastroenterol

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ObjectiveThe utility of International Classiﬁcation of Diseases (ICD) codes relies on the accuracy of clinical reporting and administrative coding, which may be influenced by country-specific codes and coding rules. This study explores the accuracy and limitations of the Australian Modification of the 10th revision of ICD (ICD-10-AM) to detect the presence of cirrhosis and a subset of key complications for the purpose of future large-scale epidemiological research and healthcare studies.Design/methodICD-10-AM codes in a random sample of 540 admitted patient encounters at a major Australian tertiary hospital were compared with data abstracted from patients’ medical records by four blinded clinicians. Accuracy of individual codes and grouped combinations was determined by calculating sensitivity, positive predictive value (PPV), negative predictive value and Cohen’s kappa coefficient (κ).ResultsThe PPVs for ‘grouped cirrhosis’ codes (0.96), hepatocellular carcinoma (0.97) ascites (0.97) and ‘grouped varices’ (0.95) were good (κ all >0.60). However, codes under-detected the prevalence of cirrhosis, ascites and varices (sensitivity 81.4%, 61.9% and 61.3%, respectively). Overall accuracy was lower for spontaneous bacterial peritonitis (‘grouped’ PPV 0.75; κ 0.73) and the poorest for encephalopathy (‘grouped’ PPV 0.55; κ 0.21). To optimise detection of cirrhosis-related encounters, an ICD-10-AM code algorithm was constructed and validated in an independent cohort of 116 patients with known cirrhosis.ConclusionMultiple ICD-10-AM codes should be considered when using administrative databases to study the burden of cirrhosis and its complications in Australia, to avoid underestimation of the prevalence, morbidity, mortality and related resource utilisation from this burgeoning chronic disease.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: What Are the New Findings?mentioning

confidence: 99%

See 1 more Smart Citation

ICD-10-AM codes for cirrhosis and related complications: key performance considerations for population and healthcare studies

Hayward¹,

Johnson²,

McKillen³

et al. 2020

BMJ Open Gastroenterol

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“…Existing evidence shows that ICD-10 coding is valid for defining overall cirrhosis and chronic liver diseases in most of the data sources used to assemble the cause-ofdeath database but does not have the required accuracy for reporting cirrhosis by the five causes estimated in the current study. 23,24 The models that we used to split the parent cirrhosis mortality and morbidity into the five causes are described below.…”

Section: Overviewmentioning

confidence: 99%

The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Sepanlou¹,

Safiri²,

Bisignano³

et al. 2020

The Lancet Gastroenterology & Hepatology

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528

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Background Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. Methods We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. Findings In 2017, cirrhosis caused more than 1•32 million (95% UI 1•27-1•45) deaths (440 000 [416 000-518 000; 33•3%] in females and 883 000 [838 000-967 000; 66•7%] in males) globally, compared with less than 899 000 (829 000-948 000) deaths in 1990. Deaths due to cirrhosis constituted 2•4% (2•3-2•6) of total deaths globally in 2017 compared with 1•9% (1•8-2•0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21•0 (19•2-22•3) per 100 000 population in 1990 to 16•5 (15•8-18•1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32•2 [25•8-38•6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10•1 [9•8-10•5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3•7 [3•3-4•0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103•3 [64•4-133•4] per 100 000 in 2017). There were 10•6 million (10•3-10•9) prevalent cases of decompensated cirrhosis and 112 million (107-119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the ot...

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“…The performance of diagnostic codes is also etiology dependent. Performance is best for viral hepatitis, moderate for ALD, and worst for NAFLD [8,13,14].…”

Section: Identifying Cirrhosis With Administrative Datamentioning

confidence: 99%

The Use of Administrative Data to Investigate the Population Burden of Hepatic Encephalopathy

Bloom

Tapper

2020

JCM

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Hepatic encephalopathy (HE) is a devastating complication of cirrhosis with an increasing footprint in global public health. Although the condition is defined using a careful history and examination, we cannot accurately measure the true impact of HE relying on data collected exclusively from clinical studies. For this reason, administrative data sources are necessary to study the population burden of HE. Administrative data is generated with each health care encounter to account for health care resource utilization and is extracted into a dataset for the secondary purpose of research. In order to utilize such data for valid analysis, several pitfalls must be avoided—specifically, selecting the particular database capable of meeting the needs of the study’s aims, paying careful attention to the limits of each given database, and ensuring validity of case definition for HE specific to the dataset. In this review, we summarize the types of data available for and the results of administrative data studies of HE.

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Positive Predictive Value of International Classification of Diseases, 10th Revision, Codes for Cirrhosis and Its Related Complications

Cited by 76 publications

References 6 publications

ICD-10-AM codes for cirrhosis and related complications: key performance considerations for population and healthcare studies

ICD-10-AM codes for cirrhosis and related complications: key performance considerations for population and healthcare studies

The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

The Use of Administrative Data to Investigate the Population Burden of Hepatic Encephalopathy

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