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Validation of ICD-9 diagnostic codes for bronchopulmonary dysplasia in Quebec's provincial health care databases
J S Landry1, D Croitoru, D Menzies
1Respiratory Epidemiology and Clinical Research Unit, McGill University, Montréal, Quebec, Canada. Jennifer.landry@mcgill.ca
Insights
ICD-9 codes accurately identify bronchopulmonary dysplasia (BPD) cases in administrative data, though milder BPD cases may be missed. This high specificity allows for reliable health care utilization analyses of BPD in preterm infants.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Health Informatics
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease resulting from neonatal lung injury.
- Accurate identification of BPD cases is crucial for understanding its impact on healthcare utilization.
Purpose of the Study:
- To validate the accuracy of ICD-9 diagnostic codes for identifying BPD in administrative healthcare databases.
- To assess the feasibility of using these codes for large-scale health care utilization analyses.
Main Methods:
- Retrospective cohort study of preterm infants admitted to Montréal Children's Hospital (1983-1992).
- BPD cases identified via ICD-9 codes in provincial databases (medical services, MED-ECHO) and matched with confirmed BPD cases.
- Analysis of concordance, sensitivity, and specificity of ICD-9 codes for BPD detection.
Main Results:
- ICD-9 codes demonstrated high specificity (97.6%-98.0%) for BPD identification.
- Sensitivity was lower (45.0%-52.4%), with milder BPD cases being more frequently missed.
- No significant differences in gestational age, birth weight, or Apgar scores between true positive and false negative BPD subjects.
Conclusions:
- ICD-9 diagnostic codes possess adequate specificity for routine use in Quebec's provincial healthcare databases for BPD.
- The lower sensitivity may lead to underestimation of BPD's long-term impact on preterm infant healthcare utilization.
- Further refinement of case ascertainment may be needed to capture all BPD cases.
Introduction:
Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease caused by neonatal lung injury. The aim of this study was to validate the use of ICD-9 diagnostic codes for BPD in administrative databases to allow for their use in health care utilization analyses.
Methods:
The validation process used a retrospective cohort composed of preterm infants, with or without respiratory complications, admitted to the Montréal Children's Hospital, Montréal, Quebec, between 1983 and 1992. BPD subjects were identified using ICD-9 diagnostic codes in the provincial administrative databases (medical services and MED-ECHO) and then matched with subjects with confirmed BPD from the validation cohort. We examined concordance and estimated sensitivity and specificity associated with the use of these diagnostic codes for BPD.
Results:
True positive and false negative BPD subjects did not differ significantly according to gestational age, birth weight and Apgar scores. False positive BPD subjects were found to have significantly lower gestational age than true negative subjects. The use of the ICD-9 diagnostic codes for BPD was associated with a specificity between 97.6% and 98.0%. The sensitivity was lower at 45.0% and 52.4% for the medical services and MED-ECHO databases, respectively. Milder cases of BPD tended to be missed more frequently than more severe cases.
Conclusion:
The specificity of the use of ICD-9 diagnostic codes for BPD in the Quebec provincial health care databases is adequate to allow its routine use. Its lower sensitivity for milder cases will likely result in an underestimation of the impacts of BPD on the long-term health care utilization of preterm infants.
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