Browsing by Autor "Antoine Bejjani"

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Abstract 14344: Pitfalls of ICD-10 Codes for Identifying Pulmonary Embolism in Electronic Records: Results From the Multicenter PE-EHR+ Study
(Lippincott Williams & Wilkins, 2023) Behnood Bikdeli; Antoine Bejjani; Candrika D. Khairani; Ying-Chih Lo; David Jiménez; Stefano Barco; Shiwani Mahajan; César Caraballo; Eric A. Secemsky; Frederikus A. Klok
Background: Many research studies from electronic databases and even the American Heart Association annual statistics for pulmonary embolism (PE) rely on the International Classification of Disease, 10 th modification (ICD-10) codes. However, the validity of ICD-10 codes for PE remains uncertain. Methods: Using a pre-specified protocol, we identified three groups of patients in the Mass General-Brigham Health system hospitals (MGB, 2016-2021) in equal distribution: Those with ICD-10 Principal discharge codes for PE, those with ICD-10 secondary codes for PE, and those without codes for PE (N=578 each). The accuracy of ICD-10 codes for identification of PE was assessed in reference to review of each chart by two independent physicians who used pre-specified criteria for presence of PE. Weighted estimates were obtained by considering the total of number of hospitalizations at MGB in each group. Results: After excluding duplicates, 1712 entered the analysis (age: 60.6 years, 52.3% female). Using the ICD-10 PEs only in the Principal discharge diagnosis, sensitivity and specificity were 60.3% and 94.6%, respectively. Although use of Principal-or-secondary ICD-10 PE codes had a sensitivity of 99.8% in the study sample, the weighted sensitivity in the parent cohort was reduced to 83.2%. The positive predictive value of Principal ICD-10 discharge codes and Principal-or-secondary ICD-10 codes were 91.9% and 79.2%, respectively (Table). Conclusions: Although the Principal discharge diagnosis codes for PE have an excellent positive predictive value, they miss nearly 40% of new PE events in hospitalized patients. Integration of secondary discharge codes only partially improves the sensitivity at the cost of reducing the positive predictive value, highlighting the need for modified strategies, such as use combination with procedure codes, or use of natural language processing -when feasible -for identification of patients with PE.
Abstract 16342: Age- and Sex-Differences in Accuracy of ICD-10 Codes for Identifying Adults With Pulmonary Embolism: PE-EHR+ Study
(Lippincott Williams & Wilkins, 2023) Shiwani Mahajan; Ying-Chih Lo; Antoine Bejjani; Candrika D. Khairani; David Jiménez; Stefano Barco; César Caraballo; Eric A. Secemsky; Frederikus A. Klok; Andetta R. Hunsaker
Background Age and sex-differences exist in presentation of adults with pulmonary embolism (PE). However, it remains unclear if these differences influence the accuracy of International Classification of Diseases, Tenth Revision (ICD-10) codes used for identification of PE. Methods: Using multicenter data from Mass General-Brigham Health System (2016-2021), patients were randomly selected from 3 groups: 578 patients with Principal Discharge codes for PE, 578 with Secondary Discharge codes for PE, and 578 without codes for PE. The reference standard for identification of PE was manual chart review by 2 independent physicians. Sensitivity, specificity, and positive and negative predictive values were determined by age (<65 vs ≥65 years) and sex (female vs male). Weighted estimates were obtained by using the total number of hospitalizations. Results: Among 1712 patients included in final analyses, 896 (52.3%) were female and 775 (45.3%) were ≥65 years. Use of Principal-or-Secondary ICD-10 codes had a similar sensitivity by sex (99.5% vs 100% among females vs males) and age (99.8% among both groups) in the study sample. The weighted sensitivity among females was 72.8% (vs 100% for males) and 80.4% among patients ≥65 years (vs 85.2% for <65 years). In the weighted cohort, the positive predictive value was 78.2% among females (vs 80.3% for males) and 78.3% among those ≥65 years (vs 80.0% for <65 years) (Table). Age and sex-differences in the diagnostic accuracy were similarly observed in analyses restricted to Principal, or to Secondary codes. Conclusions: Principal-or-Secondary ICD-10 codes had lower sensitivity and positive predictive value among females and older adults, though the sex-differences in sensitivity may be influenced by limited number of false negatives in this study. Additionally, Secondary codes had higher false positives among older adults. These findings may have important implications for identification of patients with PE using ICD-10 codes.
Abstract 379: The Accuracy Of ICD-10 Discharge Diagnosis Codes For Identification Of Isolated Sub-Segmental Pulmonary Embolism: A PE-EHR+ Substudy
(Lippincott Williams & Wilkins, 2023) Antoine Bejjani; Candrika D. Khairani; Ying-Chih Lo; David Jiménez; Stefano Barco; Shiwani Mahajan; César Caraballo; Frederikus A. Klok; Eric A. Secemsky; Ayaz Aghayev
Introduction: International Classification of Diseases 10 th revision (ICD-10) discharge diagnosis codes are widely used for research studies that use electronic databases. The accuracy of the codes for identifying patients with isolated sub-segmental pulmonary embolism (issPE) is unknown. Methods: We used data from the Mass General Brigham (MGB) health system (01/2016-12/2021) and included 1,000 patients randomly selected from 3 groups: Patients with ICD-10 Principal Discharge Diagnosis codes for PE, patients with secondary Discharge Diagnosis codes for PE, and patients with no ICD-10 codes for PE. Weighted estimates were obtained by considering the total number of hospitalizations in each category at MGB hospitals. Accuracy of the codes was assessed by two independent physicians who reviewed discharge summaries, daily notes, and radiology reports. Results: Of 1,000 records reviewed, 993 were included (age: 62.4±17.0 years, 54.8% female). Manual chart review found 493 patients with acute PE, including 59 (12.0%) with issPE. Of these 59 patients, 58 (98.3%) had ICD-10 codes for PE. However, only in 8 (13.6%) cases, PE codes were specified as being limited to subsegmental vessels (issPE). In turn, 23 additional cases with Principal-or-secondary ICD-10 codes for issPE did not have acute issPE during index hospitalization per review of records. The sensitivity and specificity for issPE codes in Principal or secondary discharge position were 13.6% and 99.5% (Table, panel A). Positive predictive value in the weighted sample was 26.2% (Table, panel B). Conclusion: Although specificity and negative predictive value of ICD-10 codes in Principal-or-secondary discharge diagnosis position for issPE are excellent, sensitivity and positive predictive value are low, highlighting the need for revised algorithms or use of natural language processing for data sources that include radiology reports.