The use of administrative health data is increasingly common for the study of various medical and surgical diseases. The validity of diagnosis codes for the study of benign upper gastrointestinal disorders has not been well studied.
The authors abstracted the charts for 590 adult patients who underwent upper gastrointestinal endoscopy between January 1, 2000 and June 30, 2001 in Toronto, Ontario, Canada. Clinical diagnoses from medical records were compared with International Classification of Diseases Version 9 (ICD-9) codes in electronic hospital discharge abstracts. The primary analysis aimed to determine the sensitivity, specificity, and positive predictive value (PPV) of a most responsible “esophagitis” diagnosis code for the prediction of esophagitis. Secondary analyses determined the performance characteristics of the diagnostic codes for esophageal ulcer, esophageal stricture, gastroesophageal reflux disease (GERD), gastritis, gastric ulcer, and duodenal ulcer.
The authors linked 500 patient records to electronic discharge abstracts. When listed as the most responsible diagnosis for admission, the ICD-9 codes for esophagitis showed a sensitivity of 46.79%, a specificity of 98.83%, and a PPV of 94.81%. When listed as a secondary diagnosis, the ICD-9 codes showed a sensitivity of 70.51%, a specificity of 97.67%, and a PPV of 93.22%. The diagnostic properties of ICD-9 codes for GERD (most responsible, secondary) were as follows: sensitivity (56.10%, 78.66%), specificity (98.51%, 96.73%), and PPV (94.84%, 92.14%).
The ICD-9 diagnosis codes for benign upper gastrointestinal diseases are highly specific and associated with strong PPVs, but have poor sensitivity.
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Bloom BS, Jayadevappa R, Wahl P, Cacciamanni J (2001) Time trends in cost of caring for people with gastroesophageal reflux disease. Am J Gastroenterol 96(8 Suppl): S64–S69
Cooper GS, Mourad WA, Koroukian SM (2004) Diagnosis and treatment of gastroesophageal reflux disease in Ohio Medicaid patients: practice patterns and temporal trends. Pharmacoepidemiol Drug Safety 13: 21–27
Delco F, El Serag HB, Sonnenberg A (1999) Celiac sprue among U.S. military veterans: associated disorders and clinical manifestations. Dig Dis Sci 44: 966–972
Delco F, Sonnenberg A (1998) Associations between hemorrhoids and other diagnoses. Dis Colon Rectum 41: 1534–1541
El Serag HB, Sonnenberg A (1999) Outcome of erosive reflux esophagitis after Nissen fundoplication. Am J Gastroenterol 94: 1771–1776
Finlayson SR, Laycock WS, Birkmeyer JD (2003) National trends in utilization and outcomes of antireflux surgery. Surg Endosc 17: 864–867
Holzman MD, Mitchel EF, Ray WA, Smalley WE (2001) Use of healthcare resources among medically and surgically treated patients with gastroesophageal reflux disease: a population-based study. J Am Coll Surg 192: 17–241
Khaitan L, Ray WA, Holzman MD, Smalley WE (2003) Health care utilization after medical and surgical therapy for gastroesophageal reflux disease: a population-based study, 1996 to 2000. Arch Surg 138: 1356–1361
Landis JR, Kock GG (1977) The measurement of observer agreement for categorical data. Biometrics 33: 159–174
Terea L, Fein M, Ritter MP, Bremner CG, Crookes PF, Peters JH, Hagen JA, DeMeester TR (1997) Can the combination of symptoms and endoscopy confrim the presence of gastroesophageal reflux disease? Am Surg 63: 933–936
Tran T, Spechler SJ, Richardson P, El Serag HB (2005) Fundoplication and the risk of esophageal cancer in gastroesophageal reflux disease: a Veterans Affairs cohort study. Am J Gastroenterol 100: 1002–1008
Williams J, Young W (1996) A summary of studies on the quality of health care administrative databases in Canada. In: Goel V, Williams J, Anderson G, Blackstien-Hirsch P, Fooks C, Naylor D (eds) Patterns of health care in Ontario. 2nd ed. Canadian Medical Association, Ottawa
This study was funded by a grant from the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), the Canadian Association of General Surgeons (CAGS), and the Canadian Institutes of Health Research (CIHR). David Urbach is a Career Scientist of the Ontario Ministry of Health and Long-Term Care, Health Research Personnel Development Program, and Tyco Chair of Minimally Invasive Surgery at the University Health Network. We thank Drs. Maria Cino, Fred Saibil, Lawrence Cohen, and Flavio Habal for allowing us to review their patient charts.
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Lopushinsky, S.R., Covarrubia, K.A., Rabeneck, L. et al. Accuracy of administrative health data for the diagnosis of upper gastrointestinal diseases. Surg Endosc 21, 1733–1737 (2007). https://doi.org/10.1007/s00464-006-9136-1
- Gastrointestinal diseases
- Health services
- Predictive value of tests
- Sensitivity and specificity