scholarly journals Validity of discharge ICD-10 codes in detecting the etiologies of endogenous Cushing’s syndrome

2019 ◽  
Vol 8 (8) ◽  
pp. 1186-1194
Author(s):  
Jingya Zhou ◽  
Meng Zhang ◽  
Lin Lu ◽  
Xiaopeng Guo ◽  
Lu Gao ◽  
...  
Keyword(s):  
Administrative Data ◽  
Cushing’S Syndrome ◽  
Predictive Value ◽  
Cushing's Syndrome ◽  
Adrenocortical Adenoma ◽  
Icd 10 ◽  
Data Source ◽  
Low Sensitivity ◽  
Sensitivity Specificity ◽  
Symptomatic Diagnosis

Objective To investigate the validity of discharge ICD-10 codes in detecting the etiology of endogenous Cushing’s syndrome (CS) in hospitalized patients. Methods We evaluated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CS etiology-related ICD-10 codes or code combinations by comparing hospital discharge administrative data (DAD) with established diagnoses from medical records. Results Coding for patients with adrenocortical adenoma (ACA) and those with bilateral macronodular adrenal hyperplasia (BMAH) demonstrated disappointingly low sensitivity at 78.8% (95% CI: 70.1–85.6%) and 83.9% (95% CI: 65.5–93.9%), respectively. BMAH had the lowest PPV of 74.3% (95% CI: 56.4–86.9%). In confirmed ACA patients, the sensitivity for ACA code combinations was higher in patients initially admitted to the Department of Endocrinology before surgery than that in patients directly admitted to the Department of Urology (90.0 vs 73.1%, P = 0.033). The same phenomenon was observed in the PPV for the BMAH code (100.0 vs 60.9%, P = 0.012). Misinterpreted or confusing situations caused by coders (68.1%) and by the omission or denormalized documentation of symptomatic diagnosis by clinicians (26.1%) accounted for the main source of coding errors. Conclusions Hospital DAD is an effective data source for evaluating the etiology of CS but not ACA and BMAH. Improving surgeons’ documentation, especially in the delineation of symptomatic and locative diagnoses in discharge abstracts; department- or disease-specific training for coders and more multidisciplinary collaboration are ways to enhance the applicability of administrative data for CS etiologies.

scholarly journals Demographic Characteristics, Etiology, and Comorbidities of Patients with Cushing’s Syndrome: A 10-Year Retrospective Study at a Large General Hospital in China

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Jingya Zhou ◽  
Meng Zhang ◽  
Xue Bai ◽  
Shengnan Cui ◽  
Cheng Pang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Fatty Liver ◽  
Cushing’S Syndrome ◽  
Osteoporotic Fractures ◽  
Cushing's Syndrome ◽  
Demographic Characteristics ◽  
Ectopic Acth Syndrome ◽  
Adrenocortical Adenoma ◽  
Ectopic Acth ◽  
Icd 10

Purpose. To investigate the demographic characteristics, etiology, and comorbidities of Cushing’s syndrome (CS) patients at a large medical center in China. Methods. Records on CS patients discharged from 2008 to 2017 were retrieved from the hospital discharge abstract database (DAD) using ICD-10 codes. Demographic characteristics, etiology, and comorbidity data were analyzed. Results. Cushing’s disease (CD) accounted for 63.0% of CS patients, followed by adrenocortical adenoma (ACA) (20.9%), primary bilateral macronodular adrenal hyperplasia (BMAH) (6.2%), ectopic ACTH syndrome (EAS) (5.9%), primary pigmented nodular adrenocortical disease (PPNAD) (1.8%), and adrenocortical carcinoma (ACC) (1.0%). CD, ACA, ACC, and PPNAD presented marked preponderances in women (4.1 : 1, 10.5 : 1, 4.3 : 1, and 2.3 : 1, respectively), while BMAH (59.8%) and EAS (51.0%) showed slightly higher preponderances in men. CD patients were younger than ACA and EAS patients (36.1±12.9 years vs. 39.4±12.7 years and 36.1±12.9 years vs. 41.0±15.8, P<0.001); PPNAD patients were the youngest (24.2±10.8 years, P<0.001), and BMAH patients were the oldest (51.3±9.9 years, P<0.001). Hypertension, diabetes mellitus, osteoporosis without fractures, osteoporotic fractures, dyslipidemia, and fatty liver occurred more frequently in CD patients than in ACA patients (P<0.001 for all). Osteoporotic fractures were observed more frequently in PPAND than in ACA (26.7% vs. 9.0%, P<0.001) and BMAH (26.7% vs. 4.9%, P<0.001) patients. EAS patients had more severe and diverse comorbidities, with higher prevalences of hypokalemia (52.0%), diabetes mellitus (61.2%), and osteoporotic fractures (28.6%). When adjusted for age, male CD patients were associated with hypertension (OR = 2.266, 95% CI: 1.524–3.371, and P<0.001), osteoporotic fractures (OR = 2.274, 95% CI: 1.568–3.298, and P<0.001), fatty liver (OR = 1.435, 95% CI: 1.028–2.003, and P=0.034), and hypokalemia (OR = 1.944, 95% CI: 1.280–2.951, and P=0.002). Conclusions. The proposed method efficiently evaluates CS patients’ epidemiological profiles using hospital DADs with ICD-10 codes and thus may enrich the limited epidemiological data and contribute to clinical practice for CS.

Abstract P71: The Accuracy of Coded Obesity in an Administrative Database

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Billie-Jean Martin ◽  
Guanmin Chen ◽  
Diane Galbraith ◽  
Merril L Knudtson ◽  
William A Ghali ◽  
...  
Keyword(s):  
Administrative Data ◽  
Predictive Value ◽  
Class I ◽  
Administrative Databases ◽  
Administrative Database ◽  
Diagnostic Code ◽  
Discharge Abstract Database ◽  
Diagnosis Codes ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Objective: Obesity is becoming an increasingly prevalent problem. Gathering information on the adiposity of a population is difficult, so being able to take advantage of existing data, such as that in administrative databases, is appealing. The objective of our study was to assess the validity of obesity coding in administrative databases. Methods: This study was conducted using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) database and the Discharge Abstract Database (DAD) for Calgary. BMI was calculated within APPROACH; BMI ≥30kg/m2 defined obesity. In the DAD obesity was defined by diagnosis codes 278 (ICD-9-CM) and E65-E68 (ICD-10). Databases were linked using provincial health numbers. The sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of a diagnosis of obesity in the DAD was determined using the obesity diagnosis in APPROACH as the referent. The accuracy of coding obesity was compared across demographic categories and diagnoses. Results: A total of 17,380 subjects included in the analysis. The study population was largely male (68.8%) and had a mean BMI of 26.96 kg/m2. The overall sensitivity of a diagnosis of obesity in the administrative data was 7.75%. However, it was highly specific at 98.98%, with a NPV of 80.84% and a PPV of 65.94%. When considered by year, there were minor variations in the sensitivity of obesity coding in the administrative data, but it remained poor at under 10% throughout. The prevalence of obesity and the PPV was higher amongst those subjects with conditions associated with obesity, including diabetes and hypertension. Of those coded obese in DAD, the majority (72.89%) were Class I obese; of those not coded obese, 84.31% were Class I obese. Conclusions: Obesity coding in the DAD is poor, as reflected in the low sensitivity of the diagnostic code. However, once obesity is coded in this database, it is coded highly accurately. At present, using administrative databases to define cohorts of obese subjects for surveillance is not a viable option.

381 Role of CT scans of abdomen and pelvis in management of patients with immunotherapy-induced colitis

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A406-A406
Author(s):  
Juan Ibarra Rovira ◽  
Raghunandan Vikram ◽  
Selvi Thirumurthi ◽  
Bulent Yilmaz ◽  
Heather Lin ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Clinical Diagnosis ◽  
Predictive Value ◽  
Clinical Symptoms ◽  
Cytotoxic T Lymphocyte ◽  
Checkpoint Inhibitors ◽  
Ct Scans ◽  
Wall Thickening ◽  
Low Sensitivity ◽  
Sensitivity Specificity

BackgroundColitis is one of the most common immune-related adverse event in patients who receive immune checkpoint inhibitors targeting cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death-1 (PD-1). Although radiographic changes are reported on computed tomography such as mild diffuse bowel thickening or segmental colitis, the utility of CT in diagnosis of patients with suspected immune-related colitis is not well studied.MethodsCT scans of the abdomen and pelvis of 34 patients on immunotherapy with a clinical diagnosis of immunotherapy induced colitis and 19 patients receiving immunotherapy without clinical symptoms of colitis (control) were enrolled in this retrospective study. Segments of the colon (rectum, sigmoid, descending, transverse, ascending and cecum) were assessed independently by two fellowship trained abdominal imaging specialists with 7 and 13 years‘ experience who were blinded to the clinical diagnosis. Each segment was assessed for mucosal enhancement, wall thickening, distension, peri-serosal fat stranding. Any disagreements were resolved in consensus. The degree of distension and the spurious assignment of wall thickening were the most common causes for disagreement. The presence of any of the signs was considered as radiographic evidence of colitis.ResultsCT evidence of colitis was seen in 16 of 34 patients with symptoms of colitis. 7 of 19 patients who did not have symptoms of colitis showed signs of colitis on CT. The sensitivity, specificity, Positive Predictive Value and Negative Predictive Value for colitis on CT is 47%, 63.2%, 69.5% and 40%, respectively.ConclusionsCT has a low sensitivity, specificity and negative predictive value for the diagnosis of immunotherapy-induced colitis. CT has no role in the diagnosis of patients suspected of having uncomplicated immune-related colitis and should not be used routinely for management.Trial RegistrationThis protocol is not registered on clinicaltrials.gov.Ethics ApprovalThis protocol was IRB approved on: 11/16/2015 - IRB 4 Chair Designee FWA #: 00000363 OHRP IRB Registration Number: IRB 4 IRB00005015ConsentThis protocol utilizes an IRB approved waiver of consent.

Drawing the line in the Edinburgh Postnatal Depression Scale (EPDS): a vital decision

2011 ◽  
Vol 23 (1) ◽  
Author(s):  
Dagmar Lagerberg ◽  
Margaretha Magnusson ◽  
Claes Sundelin
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Postnatal Depression ◽  
Edinburgh Postnatal Depression Scale ◽  
Depression Scale ◽  
Child Interaction ◽  
Mother Child Interaction ◽  
Problem Behaviours ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Abstract Background: The Edinburgh Postnatal Depression Scale (EPDS) is widely used in early child health care. This study examined the appropriateness of the recommended EPDS cut-off score 11/12. Methods: Two main analyses were performed: 1. Associations between EPDS scores and maternal health behaviour, stress, life events, perceived mother-child interaction quality and child behaviour. 2. Screening parameters of the EPDS, i.e., sensitivity, specificity and positive predictive value. EPDS scores were available for 438 mothers and maternal questionnaires for 361 mothers. Results: Already in the EPDS score intervals 6–8 and 9–11, there were notable adversities, according to maternal questionnaires, in stress, perceived quality of mother-child interaction, perceived child difficultness and child problem behaviours. Using maternal questionnaire reports about sadness/distress postpartum as standard, the recommended EPDS cut-off score 11/12 resulted in a very low sensitivity (24%). The cut-off score 6/7 yielded a sensitivity of 61%, a specificity of 82% and a positive predictive value of 61%. Conclusions: In terms of both clinical relevance and screening qualities, an EPDS cut-off score lower than 11/12 seems recommendable.

High [18F] 2-fluoro-2-deoxy-d-glucose (FDG) uptake of adrenocortical adenoma showing subclinical Cushing's syndrome

2003 ◽  
Vol 17 (5) ◽  
pp. 403-406 ◽  
Author(s):  
Akiko Shimizu ◽  
Noboru Oriuchi ◽  
Yoshito Tsushima ◽  
Tetsuya Higuchi ◽  
Jun Aoki ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Adrenocortical Adenoma ◽  
Subclinical Cushing’S Syndrome ◽  
Fdg Uptake

scholarly journals Validation of a Case Definition for Pediatric Brain Injury Using Administrative Data

2017 ◽  
Vol 44 (2) ◽  
pp. 161-169 ◽  
Author(s):  
Jane McChesney-Corbeil ◽  
Karen Barlow ◽  
Hude Quan ◽  
Guanmin Chen ◽  
Samuel Wiebe ◽  
...  
Keyword(s):  
Brain Injury ◽  
Administrative Data ◽  
Predictive Value ◽  
External Validation ◽  
Secondary Data ◽  
Population Based ◽  
Case Definition ◽  
Case Definitions ◽  
Icd 10 ◽  
Pediatric Tbi

AbstractBackground: Health administrative data are a common population-based data source for traumatic brain injury (TBI) surveillance and research; however, before using these data for surveillance, it is important to develop a validated case definition. The objective of this study was to identify the optimal International Classification of Disease , edition 10 (ICD-10), case definition to ascertain children with TBI in emergency room (ER) or hospital administrative data. We tested multiple case definitions. Methods: Children who visited the ER were identified from the Regional Emergency Department Information System at Alberta Children’s Hospital. Secondary data were collected for children with trauma, musculoskeletal, or central nervous system complaints who visited the ER between October 5, 2005, and June 6, 2007. TBI status was determined based on chart review. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each case definition. Results: Of 6639 patients, 1343 had a TBI. The best case definition was, “1 hospital or 1 ER encounter coded with an ICD-10 code for TBI in 1 year” (sensitivity 69.8% [95% confidence interval (CI), 67.3-72.2], specificity 96.7% [95% CI, 96.2-97.2], PPV 84.2% [95% CI 82.0-86.3], NPV 92.7% [95% CI, 92.0-93.3]). The nonspecific code S09.9 identified >80% of TBI cases in our study. Conclusions: The optimal ICD-10–based case definition for pediatric TBI in this study is valid and should be considered for future pediatric TBI surveillance studies. However, external validation is recommended before use in other jurisdictions, particularly because it is plausible that a larger proportion of patients in our cohort had milder injuries.

scholarly journals Validating International Classification of Disease 10th revision algorithms for identifying influenza and respiratory syncytial virus hospitalizations

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Mackenzie A Hamilton ◽  
Andrew Calzavara ◽  
Scott D Emerson ◽  
Jeffrey C Kwong
Keyword(s):  
Respiratory Syncytial Virus ◽  
Administrative Data ◽  
Predictive Value ◽  
Hospitalized Patients ◽  
International Classification ◽  
Health Administrative Data ◽  
International Classification Of Disease ◽  
Icd 10 ◽  
Syncytial Virus

Objective: Routinely collected health administrative data can be used to efficiently assess disease burden in large populations, but it is important to evaluate the validity of these data. The objective of this study was to develop and validate International Classification of Disease 10PthP revision (ICD -10) algorithms that identify laboratory-confirmed influenza or laboratory-confirmed respiratory syncytial virus (RSV) hospitalizations using population-based health administrative data from Ontario, Canada. Study Design and Setting: Influenza and RSV laboratory data from the 2014-15 through to 2017-18 respiratory virus seasons were obtained from the Ontario Laboratories Information System (OLIS) and were linked to hospital discharge abstract data to generate influenza and RSV reference cohorts. These reference cohorts were used to assess the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ICD-10 algorithms. To minimize misclassification in future studies, we prioritized specificity and PPV in selecting top-performing algorithms. Results: 83,638 and 61,117 hospitalized patients were included in the influenza and RSV reference cohorts, respectively. The best influenza algorithm had a sensitivity of 73% (95% CI 72% to 74%), specificity of 99% (95% CI 99% to 99%), PPV of 94% (95% CI 94% to 95%), and NPV of 94% (95% CI 94% to 95%). The best RSV algorithm had a sensitivity of 69% (95% CI 68% to 70%), specificity of 99% (95% CI 99% to 99%), PPV of 91% (95% CI 90% to 91%) and NPV of 97% (95% CI 97% to 97%). Conclusion: We identified two highly specific algorithms that best ascertain patients hospitalized with influenza or RSV. These algorithms may be applied to hospitalized patients if data on laboratory tests are not available, and will thereby improve the power of future epidemiologic studies of influenza, RSV, and potentially other severe acute respiratory infections.

scholarly journals Reversible alterations in cardiac morphology and functions in a patient with Cushing's syndrome

2014 ◽  
Vol 2014 ◽  
Author(s):  
Hiroaki Iwasaki
Keyword(s):  
Cushing’S Syndrome ◽  
Interventricular Septum ◽  
Urinary Free Cortisol ◽  
Cushing's Syndrome ◽  
Left Ventricular ◽  
Multidetector Row Computed Tomography ◽  
List Type ◽  
Adrenocortical Adenoma ◽  
Cardiac Morphology ◽  
Free Cortisol

Summary A 45-year-old female was referred for endocrine evaluation of an incidental mass (31×24 mm in diameter) on the right adrenal gland. The patient was normotensive and nondiabetic, and had no history of generalised obesity (body weight, 46 kg at 20 years of age and 51.2 kg on admission); however, her waist-to-hip ratio was 0.97. Elevated urinary free cortisol levels (112–118 μg/day) and other findings indicated adrenocorticotrophic hormone-independent Cushing's syndrome due to right adrenocortical adenoma. Echocardiography before adrenalectomy revealed concentric left ventricular (LV) hypertrophy with a particular increase in interventricular septum thickness leading to impaired systolic and diastolic functions. Upon surgical remission of hypercortisolism, the asymmetric hypertrophy disappeared and the cardiac dysfunctions were considerably ameliorated. Although the mechanism(s) by which excessive cortisol contributes to LV wall thickness remain(s) unclear, serial echocardiography and cardiac multidetector-row computed tomography may support the notion that abnormal fat deposition in the myocardium owing to hypercortisolism appears to be an important factor for the reversible change in the cardiac morphology. Learning points Patients with Cushing's syndrome occasionally exhibit severe LV hypertrophy related to systolic and diastolic dysfunctions although they have neither hypertension nor diabetes mellitus. Biological remission of hypercortisolism can normalise structural and functional cardiac parameters and help in differentiating the cardiac alterations induced by excessive cortisol from those induced by other diseases. Excessive lipid accumulation within the heart before myocardial fibrosis may be implicated in reversible alterations in the cardiac morphology by Cushing's syndrome. Early diagnosis and treatment of Cushing's syndrome appear to be pivotal in preventing irreversible cardiac dysfunctions subsequent to cardiovascular events and heart failure.

Abstract TP187: Low Sensitivity and High Specificity of Administrative Data for Transient Ischemic Attacks in the Emergency Department

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Amy Y Yu ◽  
Hude Quan ◽  
Andrew McRae ◽  
Gabrielle O Wagner ◽  
Shelagh B Coutts ◽  
...  
Keyword(s):  
Emergency Department ◽  
Administrative Data ◽  
Temporal Trends ◽  
High Specificity ◽  
Reference Standards ◽  
Administrative Database ◽  
Minor Stroke ◽  
Stroke Mimics ◽  
Icd 10 ◽  
Low Sensitivity

Introduction: Accurate surveillance of TIA is important for monitoring disease burden and evaluating temporal trends. Passive surveillance is a time and cost-effective method to identify TIA using administrative data. Although TIA is primarily managed in the emergency department (ED) without admission to hospital, prior administrative data validation studies have mainly evaluated inpatient databases. We determined the validity of the ICD-10 codes to identify TIA in an ED administrative database. Methods: The study population was obtained from two ongoing studies on the diagnosis of TIA and minor stroke versus stroke mimic. Stroke mimics were actively recruited. Patients enrolled between December 1st 2013 and October 30th 2015 with an ED visit were included in the current study. ED discharge diagnoses were obtained from the National Ambulatory Care Reporting System database. We determined the sensitivity, specificity, and positive predictive value (PPV) of the ICD-10 TIA codes by using two reference standards: 1) the ED chart abstraction and 2) the 90-day final diagnosis, both adjudicated by stroke neurologists. Different case definition algorithms were tested. Results: We included 417 patients. ED adjudication showed 163 (39.1%) TIA, 155 (37.2%) ischemic stroke, and 99 (23.7%) stroke mimics. The most restrictive algorithm, defined as a TIA code in the main position had the lowest sensitivity (36.8%), but highest specificity (92.5%) and PPV (76.0%). The most inclusive algorithm, defined as a TIA code in any positions with and without query prefix had the highest sensitivity (63.8%), but lowest specificity (81.5%) and PPV (68.9%). Comparing the final 90-day diagnosis with coding showed similar results. Conclusions: TIA can be identified with high specificity, but low sensitivity from ED discharge diagnoses. By including patients with stroke mimics, we determined both the false positive and negative rates, allowing for the calculation of sensitivity and specificity. We used two reference standards to verify the accuracy of administrative data. Future studies are necessary to understand the reasons for the low sensitivity of administrative data for TIA and whether the miscoded patients are systematically different from the accurately coded ones.

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