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Published on: January 18, 2018
Sensitivity of Administrative Coding in Identifying Inpatient Acute Strokes Complicating Procedures or Other Diseases
Linxin Li1, Lucy E Binney1, Samantha Carter1
11 Centre for Prevention of Stroke and Dementia Nuffield Department of Clinical Neuroscience University of Oxford United Kingdom.
Insights
Hospital administrative codes poorly detect acute strokes during inpatient stays. Improved coding strategies are needed to accurately identify stroke complications, especially after procedures.
Area of Science:
- Medical Informatics
- Public Health Research
- Neurology
Background:
- Administrative hospital diagnostic coding data are increasingly utilized in big data research.
- Acute stroke is a significant complication following procedures like carotid interventions.
- Current data are insufficient regarding the sensitivity of administrative coding for identifying acute strokes during inpatient stays.
Purpose of the Study:
- To assess the sensitivity of International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes in identifying acute strokes occurring during hospital admissions for other reasons.
- To stratify sensitivity by coding strategies, study periods, and stroke severity.
Main Methods:
- Utilized a population-based cohort of acute strokes from 2002-2017 as the reference.
- Determined the sensitivity of ICD-10 codes for identifying strokes during other hospital admissions.
- Analyzed data stratified by coding position, study period, stroke severity (NIH Stroke Score ≥5), and admission type (surgery/procedure vs. other acute medical).
Main Results:
- Of 3011 acute strokes, 198 (6.6%) occurred during other admissions, with 122 being major strokes.
- Using stroke-specific codes in the primary position yielded a sensitivity of 33.3% for any stroke, with no improvement over time.
- Sensitivity increased to 60.6% when considering all diagnostic positions and to 65.2% when including non-specific stroke codes.
Conclusions:
- The low sensitivity of administrative coding in identifying acute strokes during inpatient stays limits its standalone use for auditing procedure complication rates.
- Current coding practices do not adequately capture stroke as a complication during other hospitalizations.
- Further research and improved coding strategies are necessary for accurate surveillance of in-hospital strokes.
Abstract:
Background Administrative hospital diagnostic coding data are increasingly used in "big data" research and to assess complication rates after surgery or acute medical conditions. Acute stroke is a common complication of several procedures/conditions, such as carotid interventions, but data are lacking on the sensitivity of administrative coding in identifying acute stroke during inpatient stay. Methods and Results Using all acute strokes ascertained in a population-based cohort (2002-2017) as the reference, we determined the sensitivity of hospital administrative diagnostic codes ( International Classification of Diseases, Tenth Revision; ICD-10) for identifying acute strokes that occurred during hospital admission for other reasons, stratified by coding strategies, study periods, and stroke severity (National Institutes of Health Stroke Scoretrend=0.54). Sensitivity was lower during admissions for surgery/procedures than for other acute medical admissions (n/% 17/23.3% versus 49/39.2%; P=0.02). Sensitivity improved to 60.6% (53.6-67.2) for all and 61.6% (50.0-72.1) for surgery/procedures if other diagnostic positions were used, and to 65.2% (58.2-71.5) and 68.5% (56.9-78.1) respectively if combined with use of all possible nonspecific stroke-related codes (ie, adding ICD-10=I62 and I65-I68). Conclusions Low sensitivity of administrative coding in identifying acute strokes that occurred during admission does not support its use alone for audit of complication rates of procedures or hospitalization for other reasons.
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