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Reliability of diagnostic coding in intensive care patients
Benoît Misset1, Didier Nakache, Aurélien Vesin
1Intensive Care Unit, Fondation Hôpital Saint-Joseph, Université Paris-Descartes, Faculté de Médecine, 185 rue Losserand, 75014 Paris, France. bmisset@hpsj.fr
Critical Care (London, England)
|July 31, 2008
Summary
Medical diagnosis coding in intensive care units (ICUs) showed poor agreement among physicians. This variability may impact the reliability of epidemiological studies using ICU patient data.
Area of Science:
- Medical Informatics
- Clinical Epidemiology
- Healthcare Administration
Background:
- Administrative coding of medical diagnoses is mandatory for intensive care unit (ICU) patient databases.
- These databases are crucial for epidemiological and economic research.
- Assessing the reliability of coding among different ICU physicians is essential for data validity.
Purpose of the Study:
- To evaluate the reliability of medical diagnosis coding between different intensive care unit (ICU) physicians.
- To determine the consistency of coding practices in a multicenter ICU database.
Main Methods:
- One hundred medical records were randomly selected from a French multicenter ICU database (Outcomerea).
- Two senior physicians independently recoded diagnoses using the International Statistical Classification of Diseases and Related Health Problems: Tenth Revision (ICD-10).
- Codes were compared to original physician codes, with specific focus on septicemia and shock diagnoses.
Main Results:
- Physicians coded an average of 4.6 diagnoses per patient, with low agreement among coders.
- The primary diagnosis was matched by both external coders in only 34% of cases.
- Only 18% of all codes were selected by all three coders, indicating significant variability.
Conclusions:
- Medical diagnosis coding in ICU patients shows considerable variation among different observers.
- This inter-observer variability can limit the interpretation and validity of research and epidemiological studies relying on diagnostic inclusion criteria.
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