Introduction

This article describes the development of a unique mapping of the Kurtzke Functional Systems Scores (KFSS) from International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes among multiple sclerosis (MS) patients within a US Integrated Delivery Network (IDN). Valid identification of increasing disability may allow deeper insight into MS progression and possible treatments.

Methods

This cohort study identified MS patients in the IDN, Intermountain Healthcare. Experienced clinicians and informaticists mapped electronic health record ICD-9-CM codes to KFSS components generating a modified Kurtzke Expanded Disability Status Scale (EDSS). Modified EDSS scores were used to assess disability progression by calculating means, medians, ranges, and changes in KFSS and modified EDSS scores.

Results

Overall, 608/2960 (20.5%) patients were identified as having MS progression and presented a wide range of scores on the EDSS 10-point scale. The median (range) first and second EDSS scores were 0 (0–6) and 5 (1–8), respectively. The median (range) change from first to second score was 5 (1–7.5). The median first KFSS score for all systems was 0, and the mean differed among components. The highest mean first KFSS score (1.06) was measured for sensory function and lowest (0.12) for cerebellar functions. Of the 544 patients with their first EDSS scores in the ≤ 2.5 group, 75.2% and 15.1% had their second EDSS scores in group 3–5.5 and ≥ 6, respectively. Of the 62 patients with their first EDSS score in the 3–5.5 group, 58.1% had their second EDSS scores in group ≥ 6.

Conclusion

This innovative mapping technique is a promising method for future comparative effectiveness and safety research of Disease-Modifying Therapy in Real-World Data repositories. Future research to validate and expand on this method in another healthcare database is encouraged.

中文翻译：

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创建真实世界数据，美国医疗保健索赔基于 Kurtzke 功能系统评分的改编，用于评估多发性硬化症的严重性和进展

介绍

本文介绍了美国综合交付网络内多发性硬化症 (MS) 患者的国际疾病分类第 9 版临床修改 (ICD-9-CM) 代码中独特的库尔茨克功能系统评分 (KFSS) 映射的开发(IDN)。对残疾增加的有效识别可以更深入地了解 MS 进展和可能的治疗方法。

方法

该队列研究在 IDN Intermountain Healthcare 中确定了 MS 患者。经验丰富的临床医生和信息学家将电子健康记录 ICD-9-CM 代码映射到 KFSS 组件，生成修改后的 Kurtzke 扩展残疾状态量表 (EDSS)。修改后的 EDSS 评分用于通过计算 KFSS 和修改后的 EDSS 评分的平均值、中位数、范围和变化来评估残疾进展。

结果

总体而言，608/2960 (20.5%) 名患者被确定为 MS 进展，并在 EDSS 10 分量表上给出了广泛的分数。第一和第二 EDSS 分数的中位数（范围）分别为 0（0-6）和 5（1-8）。从第一个分数到第二个分数的中位数（范围）变化为 5（1-7.5）。所有系统的第一个 KFSS 得分中位数为 0，并且组件之间的平均值不同。最高平均第一 KFSS 评分 (1.06) 用于感觉功能，最低 (0.12) 用于小脑功能。在 544 名首次 EDSS 评分≤2.5 组的患者中，75.2% 和 15.1% 的患者第二次 EDSS 评分分别在 3-5.5 组和≥6 组。在 3-5.5 组中获得第一次 EDSS 评分的 62 名患者中，58.1% 在组中获得第二次 EDSS 评分≥6。

结论

这种创新的映射技术是未来在现实世界数据存储库中比较疾病修饰疗法的有效性和安全性研究的有前途的方法。鼓励在另一个医疗保健数据库中验证和扩展这种方法的未来研究。