Administrative codes may have limited utility in diagnosing biliary colic in emergency department visits: A...

Area of Science:

• Gastroenterology
• Health Informatics
• Epidemiology

Background:

• Biliary colic is a frequent reason for emergency department visits.
• The natural history and surgical indications for biliary colic require further clarification.
• Current population-level studies often rely on administrative codes, which may lack diagnostic precision.

Purpose of the Study:

• To validate the accuracy of International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canadian modification (ICD-10-CA) codes for identifying biliary colic.
• To assess the ability of ICD-10-CA codes to differentiate biliary colic from other biliary diagnoses like cholecystitis.
• To evaluate the reliability of administrative data in studying the epidemiology of biliary colic.

Main Methods:

• A retrospective validation study was conducted using administrative data from two large academic hospitals.
• Patient charts with ICD-10-CA codes for biliary colic presenting to the emergency department between 2012 and 2018 were reviewed.
• Diagnostic agreement was assessed by comparing administrative codes against individually abstracted patient charts.

Main Results:

• A total of 991 patient charts were analyzed.
• A misclassification rate of 26.5% was observed, yielding a positive predictive value of 73% for biliary colic codes.
• The primary reasons for misclassification included the absence of gallstones (49.8%) and diagnoses of acute cholecystitis (27.8%).

Conclusions:

• The use of ICD-10-CA codes alone to identify biliary colic is subject to moderate inaccuracy.
• Relying solely on these codes may lead to misdiagnosis and bias in epidemiological research on biliary colic.
• Further refinement of diagnostic criteria or data validation is necessary for accurate population-level studies of biliary colic.