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Validity of cerebrovascular ICD-9-CM codes in healthcare administrative databases. The Umbria Data-Value Project

Massimiliano Orso^1,2, Francesco Cozzolino^1,2, Serena Amici³

¹Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy.

|January 10, 2020

Insights

Administrative databases accurately identify stroke cases, supporting epidemiological research. This validation confirms their reliability for assessing stroke burden and healthcare resource utilization.

Area of Science:

Neurology
Public Health
Health Informatics

Background:

Administrative databases are vital for research on cerebrovascular diseases.
Validating International Classification of Diseases, Ninth Revision (ICD-9) codes for stroke is essential for accurate epidemiological studies.
Accurate data is crucial for assessing disease burden, mortality, hospital readmissions, and healthcare resource use.

Purpose of the Study:

To validate ICD-9 codes for hemorrhagic and ischemic stroke in administrative databases.
To assess the accuracy of these codes for epidemiological research.
To enable comprehensive evaluation of stroke outcomes and healthcare resource utilization.

Main Methods:

Utilized the Umbria Region's hospital discharge abstract database (2012-2014).
Included patients over 18 diagnosed with hemorrhagic or ischemic stroke.
Performed random medical chart reviews for case ascertainment and calculated diagnostic accuracy measures.

Main Results:

High accuracy was observed for hemorrhagic stroke codes (SE 100%, SP 96-98%).
Ischemic stroke codes showed good accuracy (SE 99-100%, SP 66-87%).
Positive Predictive Values (PPV) ranged from 70% to 98%, and Negative Predictive Values (NPV) were 99-100%.

Conclusions:

Administrative databases in Umbria demonstrate high accuracy for identifying both ischemic and hemorrhagic stroke cases.
These validated databases can be reliably used for epidemiological, outcome, and health services research.
The findings support the use of these databases for comprehensive stroke burden assessment.

Read full analysis

Abstract

Background:

Validation of administrative databases for cerebrovascular diseases is crucial for epidemiological, outcome, and health services research. The aim of this study was to validate ICD-9 codes for hemorrhagic or ischemic stroke in administrative databases, to use them for a comprehensive assessment of the burden of disease in terms of major outcomes, such as mortality, hospital readmissions, and use of healthcare resources.

Methods:

We considered the hospital discharge abstract database of the Umbria Region (890,000 residents). Source population was represented by patients aged >18 discharged from hospital with a diagnosis of hemorrhagic or ischemic stroke between 2012 and 2014 using ICD-9-CM codes in primary position. We randomly selected and reviewed medical charts of cases and non-cases from hospitals. For case ascertainment we considered symptoms and instrumental tests reported in the medical charts. Diagnostic accuracy measures were computed using 2x2 tables.

Results:

We reviewed 767 medical charts for cases and 78 charts for non-cases. Diagnostic accuracy measures were: subarachnoid hemorrhage: sensitivity (SE) 100% (95% CI: 97%-100%), specificity (SP) 96% (90-99), positive predictive value (PPV) 98% (93-100), negative predictive value (NPV) 100% (95-100); intracerebral hemorrhage: SE 100% (97-100), SP 98% (91-100), PPV 98% (94-100), NPV 100% (95-100); other and unspecified intracranial hemorrhage: SE 100% (97-100), SP 96% (90-99), PPV 98% (93-100), NPV 100% (95-100); ischemic stroke due to occlusion and stenosis of precerebral arteries: SE 99% (94-100), SP 66 (57-75), PPV 70% (61-77), NPV 99% (93-100); occlusion of cerebral arteries: SE 100% (97-100), SP 87% (78-93), PPV 91% (84-95), NPV 100% (95-100); acute, but ill-defined, cerebrovascular disease: SE 100% (97-100), SP 78% (69-86), PPV % 83 (75-89), NPV 100% (95-100).

Conclusions:

Case ascertainment for both ischemic and hemorrhagic stroke showed good or high levels of accuracy within the regional healthcare databases in Umbria. This database can confidently be employed for epidemiological, outcome, and health services research related to any type of stroke.

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