The Validity of Administrative Data To Classify Patients with Spinal Column and Cord Injuries

Abstract

International Classification of Diseases (ICD) codes are used to document patient morbidity in administrative databases. Although administrative data are used for research purposes, the validity of the data to accurately describe clinical diagnostic information is uncertain. We compared the clinical diagnoses for spinal cord and column injuries from a longitudinal patient registry, the Rick Hansen Spinal Cord Injury Registry (RHSCIR), to the ICD-10 spinal injury codes from the Discharge Abstract Database (DAD) at one institution. There were 603 RHSCIR participants with data describing the spinal cord injury, and 341 had data on the spinal column injury. The validity of DAD data to describe spinal injuries was evaluated using the sensitivity and positive predictive values of specific ICD-10 codes; 5.3% of the spinal column injuries and 10.9% of the spinal cord injuries documented in RHSCIR were missed in data from the DAD using ICD-10 codes. The most problematic spinal column ICD-10 code was the dislocation of the cervical vertebra (S13.1); only 14.0% of the dislocations of the cervical vertebrae in RHSCIR were correctly coded in the DAD. The most problematic spinal cord injury ICD-10 code was the incomplete lesion of the lumbar spinal cord (S34.1X); 66.7% of incomplete lesions of the lumbar spinal cord in RHSCIR were correctly coded in the DAD. The validity of DAD data to code spinal injuries is variable, and cannot be reliably used to classify all types of spinal injuries. Patient registries, such as RHSCIR, should be used if accurate detailed diagnostic data are required.

An administrative data algorithm to identify traumatic spinal cord injured patients: a validation study

“…However, given that our results are generally similar to other regions in Canada, 5 and Europe, 4 we feel our ICD10 CIHI-DAD results are broadly applicable.…”

“…These results are similar to those published in a validation study that compared the CIHI-DAD lesion level data with the RHSCIR. 5 Only the RCG codes for Paraplegia (suggesting a thoracic or lumbar SCI injury) had a low proportion of false negative patients (6%).…”

“…16,17 Hagen et al 4 found that a combination of TSCI ICD10 codes performed better than previous ICD iterations, with a sensitivity of 84%, a specificity of 97% and a PPV of 88%. Finally, Noonan et al 5 compared the accuracy of level specific information from hospital discharge ICD10 codes with the prospectively collected lesion level in the RHSCIR. The modest sensitivity and high specificity that was demonstrated in their study is very similar to our CIHI-DAD results (Table 3).…”

“…The accuracy of the SCI lesion level extraction in this study was verified using data from the Rick Hansen SCI Registry (RHSCIR), 6 which has prospective data capture of TSCI patients. 5 Of the 203 patients with an SCI that we identified, 56 were matched to their RHSCIR data record. Lesion level agreement was excellent, with an intraclass correlation coefficient of 0.90, and o6% of patients had disagreement about a cervical versus thoracic segment lesion.…”

“…Previous validation studies in this population have not included a 'true negative' population of patients to properly assess the specificity, sensitivity and negative predictive value of a data element for the identification of TSCI patients. [3][4][5] No previous studies have examined the validation of the National Rehabilitation System (NRS) or physician billing data.…”