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Validity of the International Classification of Diseases, Tenth Revision code for acute kidney injury in elderly patients at presentation to the emergency department and at hospital admission

OBJECTIVE: To evaluate the validity of the International Classification of Diseases, Tenth Revision (ICD-10) code N17x for acute kidney injury (AKI) in elderly patients in two settings: at presentation to the emergency department and at hospital admission. DESIGN: A population-based retrospective va...

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Autores principales: Hwang, Y Joseph, Shariff, Salimah Z, Gandhi, Sonja, Wald, Ron, Clark, Edward, Fleet, Jamie L, Garg, Amit X
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533048/
https://www.ncbi.nlm.nih.gov/pubmed/23204077
http://dx.doi.org/10.1136/bmjopen-2012-001821
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author Hwang, Y Joseph
Shariff, Salimah Z
Gandhi, Sonja
Wald, Ron
Clark, Edward
Fleet, Jamie L
Garg, Amit X
author_facet Hwang, Y Joseph
Shariff, Salimah Z
Gandhi, Sonja
Wald, Ron
Clark, Edward
Fleet, Jamie L
Garg, Amit X
author_sort Hwang, Y Joseph
collection PubMed
description OBJECTIVE: To evaluate the validity of the International Classification of Diseases, Tenth Revision (ICD-10) code N17x for acute kidney injury (AKI) in elderly patients in two settings: at presentation to the emergency department and at hospital admission. DESIGN: A population-based retrospective validation study. SETTING: Southwestern Ontario, Canada, from 2003 to 2010. PARTICIPANTS: Elderly patients with serum creatinine measurements at presentation to the emergency department (n=36 049) or hospital admission (n=38 566). The baseline serum creatinine measurement was a median of 102 and 39 days prior to presentation to the emergency department and hospital admission, respectively. MAIN OUTCOME MEASURES: Sensitivity, specificity and positive and negative predictive values of ICD-10 diagnostic coding algorithms for AKI using a reference standard based on changes in serum creatinine from the baseline value. Median changes in serum creatinine of patients who were code positive and code negative for AKI. RESULTS: The sensitivity of the best-performing coding algorithm for AKI (defined as a ≥2-fold increase in serum creatinine concentration) was 37.4% (95% CI 32.1% to 43.1%) at presentation to the emergency department and 61.6% (95% CI 57.5% to 65.5%) at hospital admission. The specificity was greater than 95% in both settings. In patients who were code positive for AKI, the median (IQR) increase in serum creatinine from the baseline was 133 (62 to 288) µmol/l at presentation to the emergency department and 98 (43 to 200) µmol/l at hospital admission. In those who were code negative, the increase in serum creatinine was 2 (−8 to 14) and 6 (−4 to 20) µmol/l, respectively. CONCLUSIONS: The presence or absence of ICD-10 code N17× differentiates two groups of patients with distinct changes in serum creatinine at the time of a hospital encounter. However, the code underestimates the true incidence of AKI due to a limited sensitivity.
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spelling pubmed-35330482013-01-04 Validity of the International Classification of Diseases, Tenth Revision code for acute kidney injury in elderly patients at presentation to the emergency department and at hospital admission Hwang, Y Joseph Shariff, Salimah Z Gandhi, Sonja Wald, Ron Clark, Edward Fleet, Jamie L Garg, Amit X BMJ Open Diagnostics OBJECTIVE: To evaluate the validity of the International Classification of Diseases, Tenth Revision (ICD-10) code N17x for acute kidney injury (AKI) in elderly patients in two settings: at presentation to the emergency department and at hospital admission. DESIGN: A population-based retrospective validation study. SETTING: Southwestern Ontario, Canada, from 2003 to 2010. PARTICIPANTS: Elderly patients with serum creatinine measurements at presentation to the emergency department (n=36 049) or hospital admission (n=38 566). The baseline serum creatinine measurement was a median of 102 and 39 days prior to presentation to the emergency department and hospital admission, respectively. MAIN OUTCOME MEASURES: Sensitivity, specificity and positive and negative predictive values of ICD-10 diagnostic coding algorithms for AKI using a reference standard based on changes in serum creatinine from the baseline value. Median changes in serum creatinine of patients who were code positive and code negative for AKI. RESULTS: The sensitivity of the best-performing coding algorithm for AKI (defined as a ≥2-fold increase in serum creatinine concentration) was 37.4% (95% CI 32.1% to 43.1%) at presentation to the emergency department and 61.6% (95% CI 57.5% to 65.5%) at hospital admission. The specificity was greater than 95% in both settings. In patients who were code positive for AKI, the median (IQR) increase in serum creatinine from the baseline was 133 (62 to 288) µmol/l at presentation to the emergency department and 98 (43 to 200) µmol/l at hospital admission. In those who were code negative, the increase in serum creatinine was 2 (−8 to 14) and 6 (−4 to 20) µmol/l, respectively. CONCLUSIONS: The presence or absence of ICD-10 code N17× differentiates two groups of patients with distinct changes in serum creatinine at the time of a hospital encounter. However, the code underestimates the true incidence of AKI due to a limited sensitivity. BMJ Publishing Group 2012-11-30 /pmc/articles/PMC3533048/ /pubmed/23204077 http://dx.doi.org/10.1136/bmjopen-2012-001821 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
spellingShingle Diagnostics
Hwang, Y Joseph
Shariff, Salimah Z
Gandhi, Sonja
Wald, Ron
Clark, Edward
Fleet, Jamie L
Garg, Amit X
Validity of the International Classification of Diseases, Tenth Revision code for acute kidney injury in elderly patients at presentation to the emergency department and at hospital admission
title Validity of the International Classification of Diseases, Tenth Revision code for acute kidney injury in elderly patients at presentation to the emergency department and at hospital admission
title_full Validity of the International Classification of Diseases, Tenth Revision code for acute kidney injury in elderly patients at presentation to the emergency department and at hospital admission
title_fullStr Validity of the International Classification of Diseases, Tenth Revision code for acute kidney injury in elderly patients at presentation to the emergency department and at hospital admission
title_full_unstemmed Validity of the International Classification of Diseases, Tenth Revision code for acute kidney injury in elderly patients at presentation to the emergency department and at hospital admission
title_short Validity of the International Classification of Diseases, Tenth Revision code for acute kidney injury in elderly patients at presentation to the emergency department and at hospital admission
title_sort validity of the international classification of diseases, tenth revision code for acute kidney injury in elderly patients at presentation to the emergency department and at hospital admission
topic Diagnostics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533048/
https://www.ncbi.nlm.nih.gov/pubmed/23204077
http://dx.doi.org/10.1136/bmjopen-2012-001821
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