Journal
ARCHIVES OF CARDIOVASCULAR DISEASES
Volume 112, Issue 1, Pages 31-43Publisher
ELSEVIER MASSON, CORP OFF
DOI: 10.1016/j.acvd.2018.07.002
Keywords
Adult congenital heart disease; Diagnostic code; Nomenclature; Electronic medical records
Categories
Funding
- Fondation pour la Recherche Medicate
- AREMCAR (Helene de Marsan Grant)
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Background. - The content of electronic medical records (EMRs) encompasses both structured data, such as billing codes, and unstructured data, including free-text reports. Epidemiological and clinical research into adult congenital heart disease (ACHD) increasingly relies on administrative claim data using the International Classification of Diseases (9th revision) (ICD-9). In France, administrative databases use ICD-10, the reliability of which is largely unknown in this context. Aims. - To assess the accuracy of ICD-10 codes retrieved from administrative claim data in the identification and classification of ACHD. Methods. - We randomly included 6000 patients hospitalized at least once in 2000-2014 in a cardiology department with a dedicated specialized ACHD Unit. For each patient, the clinical diagnosis extracted from the EMR was compared with the assigned ICD-10 codes. Performance of ICD-10 codes in the identification and classification of ACHD was assessed by estimating sensitivity, specificity and positive predictive value. Results. - Among the 6000 patients included, 780 (13%) patients with ACHD were manually identified from EMRs (107,092 documents). ICD-10 codes correctly categorized 629 as having ACHD (sensitivity 0.81, 95% confidence interval 0.78-0.83), with a specificity of 0.99 (95% confidence interval 0.99-1). The performance of ICD-10 codes in correctly categorizing the ACHD defect subtype depended on the defect, with sensitivity ranging from 0 (e.g. unspecified congenital malformation of tricuspid valve) to 1 (e.g. common arterial trunk), and specificity ranging from 0.99 to 1. Conclusions. - Administrative data using ICD-10 codes is a precise tool for detecting ACHD, and may be used to establish a national cohort. Mining free-text reports in addition to coded administrative data may offset the lack of sensitivity and accuracy when describing the spectrum of congenital heart disease using ICD-10 codes. (C) 2018 Published by Elsevier Masson SAS.
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