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Characterisation of children's asthma status by ICD-9 code and criteria-based medical record review

Young Juhn1, Amiinah Kung, Robert Voigt

  • 1Department of Community Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55944, USA. juhn.young@mayo.edu

Primary Care Respiratory Journal : Journal of the General Practice Airways Group
|November 11, 2010
PubMed

Insights

Physician diagnosis codes (ICD-9) under-identify pediatric asthma cases compared to detailed medical record review. This suggests ICD codes are better for research than for tracking asthma prevalence.

Area of Science:

  • Pediatric Pulmonology
  • Clinical Informatics
  • Epidemiology

Background:

  • Accurate identification of pediatric asthma cases is crucial for understanding disease burden and guiding public health initiatives.
  • International Classification of Diseases (ICD) codes are widely used for diagnosis-based patient identification in healthcare systems.
  • The reliability of ICD codes for asthma ascertainment in children requires rigorous evaluation against established clinical criteria.

Purpose of the Study:

  • To characterize the relationship between asthma ascertainment using International Classification of Diseases, Ninth Revision (ICD-9) codes and criteria-based medical record review in children.
  • To evaluate the agreement and validity of ICD-9 code-based asthma identification compared to a gold standard medical record review.

Main Methods:

  • A comparative study was conducted to assess asthma identification in children using both ICD-9 codes and a detailed criteria-based medical record review.
  • Agreement rates and validity indices, including sensitivity, specificity, and predictive values, were calculated for the ICD-9 code approach.
  • Asthma status determined by medical record review served as the gold standard for comparison.

Main Results:

  • The agreement between ICD-9 coding and medical record review for asthma identification was 81.6%, with a kappa value of 0.28 (P<0.0001).
  • The ICD-9 code-based approach demonstrated a sensitivity of 24.0%, specificity of 97.8%, positive predictive value of 75.0%, and negative predictive value of 82.0%.
  • These results indicate a significant under-identification of pediatric asthma cases by ICD-9 codes.

Conclusions:

  • ICD-9 code-based asthma ascertainment substantially under-identifies children with asthma when compared to criteria-based medical record review.
  • While ICD codes may possess utility in etiologic research requiring physician-diagnosed cohorts, their accuracy is insufficient for robust asthma epidemiology surveillance.
  • Further research may be needed to refine diagnostic coding practices for pediatric respiratory conditions.
Abstract

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