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Related Experiment Videos

Stroke: who's counting what?

D M Reker1, B B Hamilton, P W Duncan

  • 1Department of Veterans Affairs Medical Center, Kansas City, MO 64128, USA. dean.reker@med.va.gov

Journal of Rehabilitation Research and Development
|June 8, 2001
PubMed
Summary
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Identifying stroke patients using ICD-9 codes shows significant accuracy variation. Two algorithms offer improved sensitivity or specificity, but caution is advised when using these administrative codes for stroke identification.

Area of Science:

  • Medical Informatics
  • Epidemiology
  • Health Services Research

Background:

  • International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes are frequently used for stroke patient identification in research and epidemiological studies.
  • The accuracy of these diagnostic codes in reliably identifying stroke cases has not been consistently established.

Purpose of the Study:

  • To evaluate the accuracy of ICD-9-CM codes in identifying patients diagnosed with stroke.
  • To assess the performance of different coding algorithms for stroke case ascertainment.

Main Methods:

  • A sample of 279 new stroke patients and 392 non-stroke patients were identified via medical record review across 11 Veterans Affairs Medical Centers.
  • Administrative data containing ICD-9-CM diagnoses were matched to the reviewed patient sample.

Related Experiment Videos

  • Sensitivity and specificity of individual ICD-9 codes and two distinct coding algorithms were calculated.

    • Main Results:

    • A notable variation in the accuracy of cerebrovascular ICD-9-CM codes for identifying stroke patients was observed.
    • Two coding algorithms demonstrated varying performance: Algorithm 1 achieved 91% sensitivity and 40% specificity; Algorithm 2 achieved 54% sensitivity and 87% specificity.

    Conclusions:

    • The study confirms significant variability in identifying stroke patients using ICD-9 codes, as previously reported.
    • Two proposed coding algorithms can optimize either sensitivity or specificity for stroke case ascertainment.
    • Researchers and clinicians should exercise caution when utilizing ICD-9 coded administrative data for stroke patient identification.