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Validity of International Classification of Diseases, Tenth Revision, codes for atrial fibrillation/flutter in critically ill patients with sepsis - 10/07/24

Doi : 10.1016/j.accpm.2024.101398 
Purnadeo Persaud a, Michael A. Rudoni b, Abhijit Duggal c, d, Sotoshi Miyashita e, Michael Lanspa f, g, Siddharth Dugar c, d,
a Department of Medicine, Cleveland Clinic, Cleveland, OH, USA 
b Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA 
c Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA 
d Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH, USA 
e Department of Cardiovascular Medicine Heart, Vascular, and Thoracic Institute Cleveland Clinic Foundation, Cleveland, OH, USA 
f Critical Care Echocardiography Service, Intermountain Medical Center, UT, USA 
g Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA 

Corresponding author at: 9500 Euclid Avenue, Cleveland, OH 44195, USA.9500 Euclid AvenueClevelandOH44195USA

Highlights

ICD-10 code had a high negative predictive value to identify the absence of atrial arrhythmia in critically-ill septic patients.
ICD-10 code had a high positive predictive value to identify the presence of atrial arrhythmia in critically ill septic patients.
The validity of ICD-10 with date of first documentation had modest validity in distinguishing incident from prevalent atrial arrhythmia.

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Abstract

Background

Atrial fibrillation (AF) and atrial flutter (AFL) are frequently seen in critically ill sepsis patients and are associated with poor outcomes. There is a need for further research, however, studies are limited due to challenges in identifying patient cohorts. Administrative data using the International Classification of Diseases, Tenth Revision (ICD-10) are routinely used for identifying disease cohorts in large datasets. However, the validity of ICD-10 for AF/AFL remains unexplored in these populations.

Methods

This validation study included 6554 adults with sepsis and septic shock admitted to the intensive care unit. We sought to determine whether ICD-10 coding could accurately identify patients with and without AF/AFL compared to manual chart review. We also evaluated whether the date of ICD-10 code entry could distinguish prevalent from incident AF/AFL, presuming codes dated during the index admission to be incident AF/AFL. A manual chart review was performed on 400 randomly selected patients for confirmation of AF/AFL, and validity was measured using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results

Among the 400 randomly selected patients, 293 lacked ICD-10 codes for AF/AFL. The manual chart review confirmed the absence of AF/AFL in 286 patients (NPV 97.3%, specificity 99.7%). Among the 107 patients with ICD-10 codes for AF/AFL, 106 were confirmed to have AF/AFL by manual chart review (PPV 99.1%, sensitivity 93.0%). Out of the 114 patients with confirmed AF/AFL, 44 had ICD-10 codes dated during the index admission. All 44 were confirmed to have AF/AFL, however, 18 patients had prior documentation of AF/AFL (incident AF/AFL: PPV 59.1%). Specificity for incident (95.1%) and prevalent (99.7%) AF/AFL were high; however, sensitivity was 76.5% and 77.5%, respectively.

Discussion/conclusion

ICD-10 codes perform well in identifying clinical AF/AFL in critically ill sepsis. However, their temporal specificity in distinguishing incidents from prevalent AF/AFL is limited.

Le texte complet de cet article est disponible en PDF.

Abbreviation : AF, AFL, NOAF, ICD-10, ECG, PPV, NPV

Keywords : Sepsis, Validation, Atrial tachycardia, Atrial fibrillation, Atrial flutter, ICD-10


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© 2024  The Author(s). Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 43 - N° 4

Article 101398- août 2024 Retour au numéro
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