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Value of the International Classification of Diseases code for identifying children with biliary atresia
Pornthep Tanpowpong1, Chatmanee Lertudomphonwanit1, Pornpimon Phuapradit1
1Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
The International Classification of Diseases, Tenth Revision (ICD-10) code Q44.2 shows acceptable accuracy for identifying pediatric biliary atresia cases. Combining this code with clinical data, such as pale stool history, enhances diagnostic precision for research and healthcare allocation.
Area of Science:
- Pediatric Gastroenterology
- Medical Informatics
- Diagnostic Accuracy Studies
Background:
- Identifying pediatric biliary atresia in administrative databases is crucial for research.
- Previous studies indicate that relying solely on International Classification of Diseases, Tenth Revision (ICD-10) codes can lead to misclassification.
- Accurate case identification is essential for effective research and resource allocation.
Purpose of the Study:
- To evaluate the diagnostic utility of the ICD-10 code for identifying potential pediatric biliary atresia cases.
- To assess the accuracy, sensitivity, and specificity of using ICD-10 code Q44.2 for biliary atresia diagnosis.
- To explore the potential of a diagnostic algorithm for improving case identification.
Main Methods:
- Retrospective review of medical records for patients under 18 with ICD-10 code Q44.2 (biliary atresia) or related cirrhosis codes.
- Application of a proposed diagnostic algorithm to define definite, probable, and possible biliary atresia cases.
- Statistical analysis to determine accuracy, sensitivity, specificity, and independent predictors of biliary atresia.
Main Results:
- The ICD-10 code Q44.2 demonstrated 80% accuracy and 88% sensitivity for identifying biliary atresia.
- Independent predictors for biliary atresia included the ICD-10 code Q44.2, pale stool history, and prior diagnosis before referral.
- A significant interaction between the ICD-10 code and pale stool history was observed, with an area under the curve of 0.87.
Conclusions:
- The ICD-10 code Q44.2 offers acceptable diagnostic value for pediatric biliary atresia.
- Integrating clinical information, such as pale stool history, significantly improves case identification accuracy.
- The developed diagnostic algorithm can enhance the use of administrative data for biliary atresia research and healthcare planning.
Background:
Although identifying cases in large administrative databases may aid future research studies, previous reports demonstrated that the use of the International Classification of Diseases, Tenth Revision (ICD-10) code alone for diagnosis leads to disease misclassification.
Purpose:
We aimed to assess the value of the ICD-10 diagnostic code for identifying potential children with biliary atresia.
Methods:
Patients aged <18 years assigned the ICD-10 code of biliary atresia (Q44.2) between January 1996 and December 2016 at a quaternary care teaching hospital were identified. We also reviewed patients with other diagnoses of code-defined cirrhosis to identify more potential cases of biliary atresia. A proposed diagnostic algorithm was used to define ICD-10 code accuracy, sensitivity, and specificity.
Results:
We reviewed the medical records of 155 patients with ICD-10 code Q44.2 and 69 patients with other codes for biliary cirrhosis (K74.4, K74.5, K74.6). The accuracy for identifying definite/probable/possible biliary atresia cases was 80%, while the sensitivity was 88% (95% confidence interval [CI], 82%-93%). Three independent predictors were associated with algorithm-defined definite/probable/possible cases of biliary atresia: ICD-10 code Q44.2 (odds ratio [OR], 2.90; 95% CI, 1.09-7.71), history of pale stool (OR, 2.78; 95% CI, 1.18-6.60), and a presumed diagnosis of biliary atresia prior to referral to our hospital (OR, 17.49; 95% CI, 7.01-43.64). A significant interaction was noted between ICD-10 code Q44.2 and a history of pale stool (P<0.05). The area under the curve was 0.87 (95% CI, 0.84-0.89).
Conclusion:
ICD-10 code Q44.2 has an acceptable value for diagnosing biliary atresia. Incorporating clinical data improves the case identification. The use of this proposed diagnostic algorithm to examine data from administrative databases may facilitate appropriate health care allocation and aid future research investigations.
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