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Limitations of pulmonary embolism ICD-10 codes in emergency department administrative data: let the buyer beware

Overview of attention for article published in BMC Medical Research Methodology, June 2017
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About this Attention Score

  • Above-average Attention Score compared to outputs of the same age (63rd percentile)
  • Good Attention Score compared to outputs of the same age and source (65th percentile)

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5 tweeters

Citations

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10 Dimensions

Readers on

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29 Mendeley
Title
Limitations of pulmonary embolism ICD-10 codes in emergency department administrative data: let the buyer beware
Published in
BMC Medical Research Methodology, June 2017
DOI 10.1186/s12874-017-0361-1
Pubmed ID
Authors

Kristin Burles, Grant Innes, Kevin Senior, Eddy Lang, Andrew McRae

Abstract

Administrative data is a useful tool for research and quality improvement; however, validity of research findings based on these data depends on their reliability. Diagnoses assigned by physicians are subsequently converted by nosologists to ICD-10 codes (International Statistical Classification of Diseases and Related Health Problems, 10th Revision). Several groups have reported ICD-9 coding errors in inpatient data that have implications for research, quality improvement, and policymaking, but few have assessed ICD-10 code validity in ambulatory care databases. Our objective was to evaluate pulmonary embolism (PE) ICD-10 code accuracy in our large, integrated hospital system, and the validity of using these codes for operational and health services research using ED ambulatory care databases. Ambulatory care data for patients (age ≥ 18 years) with a PE ICD-10 code (I26.0 and I26.9) were obtained from the records of four urban EDs between July 2013 to January 2015. PE diagnoses were confirmed by reviewing medical records and imaging reports. In cases where chart diagnosis and ICD-10 code were discrepant, chart review was considered correct. Physicians' written discharge diagnoses were also searched using 'pulmonary embolism' and 'PE', and patients who were diagnosed with PE but not coded as PE were identified. Coding discrepancies were quantified and described. One thousand, four hundred and fifty-three ED patients had a PE ICD-10 code. Of these, 257 (17.7%) were false positive, with an incorrectly assigned PE code. Among the 257 false positives, 193 cases had ambiguous ED diagnoses such as 'rule out PE' or 'query PE', while 64 cases should have had non-PE codes. An additional 117 patients (8.90%) with a PE discharge diagnosis were incorrectly assigned a non-PE ICD-10 code (false negative group). The sensitivity of PE ICD-10 codes in this dataset was 91.1% (95%CI, 89.4-92.6) with a specificity of 99.9% (95%CI, 99.9-99.9). The positive and negative predictive values were 82.3% (95%CI, 80.3-84.2) and 99.9% (95%CI, 99.9-99.9), respectively. Ambulatory care data, like inpatient data, are subject to coding errors. This confirms the importance of ICD-10 code validation prior to use. The largest proportion of coding errors arises from ambiguous physician documentation; therefore, physicians and data custodians must ensure that quality improvement processes are in place to promote ICD-10 coding accuracy.

Twitter Demographics

The data shown below were collected from the profiles of 5 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 29 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 29 100%

Demographic breakdown

Readers by professional status Count As %
Researcher 6 21%
Other 5 17%
Student > Ph. D. Student 4 14%
Student > Bachelor 2 7%
Student > Doctoral Student 2 7%
Other 7 24%
Unknown 3 10%
Readers by discipline Count As %
Medicine and Dentistry 14 48%
Biochemistry, Genetics and Molecular Biology 2 7%
Agricultural and Biological Sciences 1 3%
Psychology 1 3%
Nursing and Health Professions 1 3%
Other 1 3%
Unknown 9 31%

Attention Score in Context

This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 14 June 2017.
All research outputs
#5,711,112
of 11,364,689 outputs
Outputs from BMC Medical Research Methodology
#446
of 960 outputs
Outputs of similar age
#96,172
of 267,675 outputs
Outputs of similar age from BMC Medical Research Methodology
#11
of 32 outputs
Altmetric has tracked 11,364,689 research outputs across all sources so far. This one is in the 49th percentile – i.e., 49% of other outputs scored the same or lower than it.
So far Altmetric has tracked 960 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 7.8. This one has gotten more attention than average, scoring higher than 53% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 267,675 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 63% of its contemporaries.
We're also able to compare this research output to 32 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 65% of its contemporaries.