Abstract 16342: Age- and Sex-Differences in Accuracy of ICD-10 Codes for Identifying Adults With Pulmonary Embolism: PE-EHR+ Study

Abstract

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.