BACKGROUND The twenty-first century opioid crisis has spurred interest in using International Classification of Diseases (ICD) code algorithms to identify patients using illicit drugs from administrative healthcare data. We conducted a systematic review of studies that validated ICD code algorithms for illicit drug use against a reference standard of medical record data. METHODS Systematic searches of MEDLINE, EMBASE, PsycINFO, and Web of Science were conducted for studies published between 1980 and 2018 in English, French, Italian, or Spanish. We included validation studies of ICD-9 or ICD-10 code algorithms for an illicit drug use target condition (e.g., illicit drug use, abuse, or dependence (UAD), illicit drug use-related complications) given the sensitivity or specificity was reported or could be calculated. Bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies Version 2 (QUADAS-2) tool. RESULTS Six of the 1210 articles identified met the inclusion criteria. For validation studies of broad UAD (n = 4), the specificity was nearly perfect, but the sensitivity ranged from 47% to 83%, with higher sensitivities tending to occur in higher prevalence populations. For validation studies of injection drug use (IDU)-associated infective endocarditis (n = 2), sensitivity and specificity were poor due to the lack of an ICD code for IDU. For all six studies, the risk of bias for the QUADAS-2 "reference standard" and "flow/timing domains" was scored as "unclear" due to insufficient reporting. CONCLUSIONS Few studies have validated ICD code algorithms for illicit drug use target conditions, and available evidence is challenging to interpret due to inadequate reporting. PROSPERO Registration: CRD42019118401.

中文翻译：

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使用病历数据作为参考标准确定非法药物使用目标条件的国际疾病分类代码的有效性：系统评价。

背景技术二十一世纪的阿片类药物危机激发了人们对使用国际疾病分类（ICD）代码算法从管理医疗数据中识别使用非法药物的患者的兴趣。我们对研究进行了系统回顾，这些研究根据医疗记录数据的参考标准验证了非法药物使用的 ICD 代码算法。方法 对 MEDLINE、EMBASE、PsycINFO 和 Web of Science 对 1980 年至 2018 年间以英语、法语、意大利语或西班牙语发表的研究进行了系统检索。鉴于报告的敏感性或特异性，我们纳入了针对非法药物使用目标状况（例如非法药物使用、滥用或依赖（UAD）、非法药物使用相关并发症）的 ICD-9 或 ICD-10 代码算法的验证研究或者可以计算。使用诊断准确性研究质量评估第 2 版 (QUADAS-2) 工具评估偏差。结果 1210 篇文章中有 6 篇符合纳入标准。对于广泛 UAD (n = 4) 的验证研究，特异性几乎是完美的，但敏感性范围为 47% 至 83%，较高的敏感性往往发生在较高患病率的人群中。对于注射吸毒 (IDU) 相关感染性心内膜炎 (n = 2) 的验证研究，由于缺乏 IDU 的 ICD 代码，敏感性和特异性都很差。对于所有六项研究，由于报告不充分，QUADAS-2“参考标准”和“流程/时间域”的偏倚风险被评为“不清楚”。结论 很少有研究验证针对非法药物使用目标条件的 ICD 代码算法，并且由于报告不充分，现有证据难以解释。普洛斯彼罗注册号：CRD42019118401。