ABSTRACT

Purpose

To determine the predictive value of International Classification of Diseases, 9th Revision (ICD-9) codes for identifying infantile eye diagnoses.

Methods

Population-based retrospective cohort study of all residents of Olmsted County, Minnesota diagnosed at ≤1 year of age with an ocular disorder. The medical records of all infants diagnosed with any ocular disorder from January 1, 2005, through December 31, 2014, were identified. To assess ICD-9 code accuracy, the medical records of all diagnoses with ≥20 cases were individually reviewed and compared to their corresponding ICD-9 codes. Main outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-9 codes.

Results

In a cohort of 5,109 infants with ≥1 eye-related ICD-9 code, 10 ocular diagnoses met study criteria. The most frequent diagnoses were conjunctivitis (N = 1,695) and congenital nasolacrimal duct obstruction (N = 1,250), while the least common was physiologic anisocoria (N = 23). The PPVs ranged from 8.3% to 88.0%, NPVs from 96.3% to 100%, sensitivity from 3.0% to 98.7%, and specificity from 72.6% to 99.9%. ICD-9 codes were most accurate at identifying physiologic anisocoria (PPV: 88.0%) and least accurate at identifying preseptal cellulitis (PPV: 8.3%). In eye specialists versus non-eye specialists, there was a significant difference in PPV of ICD-9 codes for conjunctivitis (26.8% vs. 63.9%, p < .001), pseudostrabismus (85.9% vs. 25.0%, p < .001), and physiologic anisocoria (95.5% vs. 33.3%, p = .002).

Conclusion

The predictive value of ICD-9 codes for capturing infantile ocular diagnoses varied widely in this cohort. These findings emphasize the limitations of database research methodologies that solely utilize claims data to identify pediatric eye diseases.Abbreviations/Acronyms PPV: positive predictive value; NPV: negative predictive value; CNLDO: congenital nasolacrimal duct obstruction

中文翻译：

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国际疾病分类的准确性，第 9 次修订以识别婴儿眼病

摘要

目的

确定国际疾病分类第 9 版 (ICD-9) 代码识别婴儿眼部诊断的预测价值。

方法

对明尼苏达州奥姆斯特德县所有被诊断为 1 岁以下眼部疾病的居民进行的基于人群的回顾性队列研究。确定了从 2005 年 1 月 1 日到 2014 年 12 月 31 日期间被诊断患有任何眼部疾病的所有婴儿的医疗记录。为了评估 ICD-9 代码的准确性，对所有诊断病例≥20 例的病历进行了单独审查，并与其相应的 ICD-9 代码进行了比较。主要结果指标包括 ICD-9 代码的阳性预测值 (PPV)、阴性预测值 (NPV)、敏感性和特异性。

结果

在 5,109 名具有 ≥ 1 个眼部相关 ICD-9 代码的婴儿队列中，10 名眼部诊断符合研究标准。最常见的诊断是结膜炎 (N = 1,695) 和先天性鼻泪管阻塞 (N = 1,250)，而最不常见的是生理性瞳孔不等 (N = 23)。PPV 从 8.3% 到 88.0%，NPV 从 96.3% 到 100%，灵敏度从 3.0% 到 98.7%，特异性从 72.6% 到 99.9%。ICD-9 代码在识别生理性瞳孔不等（PPV：88.0%）方面最准确，而在识别隔前蜂窝织炎（PPV：8.3%）方面最不准确。在眼科专家与非眼科专家中，结膜炎（26.8% 对 63.9%，p < .001）、假性斜视（85.9% 对 25.0%，p ）的 ICD-9 代码的 PPV 存在显着差异< .001）和生理性瞳孔不等（95.5% 对 33.3%，p = .002）。

结论

在这个队列中，ICD-9 代码对捕获婴儿眼部诊断的预测价值差异很大。这些发现强调了仅利用索赔数据来识别小儿眼病的数据库研究方法的局限性。缩写词/缩写词PPV：阳性预测值；NPV：阴性预测值；CNLDO：先天性鼻泪管阻塞