Validity of hospital discharge diagnosis codes for stroke: The atherosclerosis risk in communities study

Sydney A. Jones, Rebecca F. Gottesman, Eyal Shahar, Lisa Wruck, Wayne D. Rosamond

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Background and Purpose-Characterizing International Classification of Disease 9th Revision, Clinical Modification (ICD-9-CM) code validity is essential given widespread use of hospital discharge databases in research. Using the Atherosclerosis Risk in Communities (ARIC) Study, we estimated the accuracy of ICD-9-CM stroke codes. Methods-Hospitalizations with ICD-9-CM codes 430 to 438 or stroke keywords in the discharge summary were abstracted for ARIC cohort members (1987-2010). A computer algorithm and physician reviewer classified definite and probable ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Using ARIC classification as a gold standard, we calculated the positive predictive value (PPV) and sensitivity of ICD-9-CM codes grouped according to the American Heart Association/American Stroke Association (AHA/ASA) 2013 categories and an alternative code grouping for comparison. Results-Thirty-three percent of 4260 hospitalizations were validated as strokes (1251 ischemic, 120 intracerebral hemorrhage, 46 subarachnoid hemorrhage). The AHA/ASA code groups had PPV 76% and 68% sensitivity compared with PPV 72% and 83% sensitivity for the alternative code groups.The PPV of the AHA/ASA code group for ischemic stroke was slightly higher among blacks, individuals <65 years, and at teaching hospitals. Sensitivity was higher among older individuals and increased over time. The PPV of the AHA/ASA code group for intracerebral hemorrhage was higher among blacks, women, and younger individuals. PPV and sensitivity varied across study sites. Conclusions-A new AHA/ASA discharge code grouping to identify stroke had similar PPV and lower sensitivity compared with an alternative code grouping. Accuracy varied by patient characteristics and study sites.

Original languageEnglish (US)
Pages (from-to)3219-3225
Number of pages7
JournalStroke
Volume45
Issue number11
DOIs
StatePublished - 2014

Fingerprint

Atherosclerosis
Stroke
American Heart Association
International Classification of Diseases
Cerebral Hemorrhage
Subarachnoid Hemorrhage
Hospitalization
Teaching Hospitals
Databases
Physicians
Research

Keywords

  • Cerebrovascular disease
  • ICD-9-CM
  • Predictive value
  • Sensitivity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Validity of hospital discharge diagnosis codes for stroke : The atherosclerosis risk in communities study. / Jones, Sydney A.; Gottesman, Rebecca F.; Shahar, Eyal; Wruck, Lisa; Rosamond, Wayne D.

In: Stroke, Vol. 45, No. 11, 2014, p. 3219-3225.

Research output: Contribution to journalArticle

Jones, Sydney A. ; Gottesman, Rebecca F. ; Shahar, Eyal ; Wruck, Lisa ; Rosamond, Wayne D. / Validity of hospital discharge diagnosis codes for stroke : The atherosclerosis risk in communities study. In: Stroke. 2014 ; Vol. 45, No. 11. pp. 3219-3225.
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abstract = "Background and Purpose-Characterizing International Classification of Disease 9th Revision, Clinical Modification (ICD-9-CM) code validity is essential given widespread use of hospital discharge databases in research. Using the Atherosclerosis Risk in Communities (ARIC) Study, we estimated the accuracy of ICD-9-CM stroke codes. Methods-Hospitalizations with ICD-9-CM codes 430 to 438 or stroke keywords in the discharge summary were abstracted for ARIC cohort members (1987-2010). A computer algorithm and physician reviewer classified definite and probable ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Using ARIC classification as a gold standard, we calculated the positive predictive value (PPV) and sensitivity of ICD-9-CM codes grouped according to the American Heart Association/American Stroke Association (AHA/ASA) 2013 categories and an alternative code grouping for comparison. Results-Thirty-three percent of 4260 hospitalizations were validated as strokes (1251 ischemic, 120 intracerebral hemorrhage, 46 subarachnoid hemorrhage). The AHA/ASA code groups had PPV 76{\%} and 68{\%} sensitivity compared with PPV 72{\%} and 83{\%} sensitivity for the alternative code groups.The PPV of the AHA/ASA code group for ischemic stroke was slightly higher among blacks, individuals <65 years, and at teaching hospitals. Sensitivity was higher among older individuals and increased over time. The PPV of the AHA/ASA code group for intracerebral hemorrhage was higher among blacks, women, and younger individuals. PPV and sensitivity varied across study sites. Conclusions-A new AHA/ASA discharge code grouping to identify stroke had similar PPV and lower sensitivity compared with an alternative code grouping. Accuracy varied by patient characteristics and study sites.",
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