描述患有妄想症的医疗患者:一项比较ICD-10代码和经过验证的图表审查方法的队列研究
Kathleen A Sheehan1,2, Saeha Shin3, Elise Hall1,4
1Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
行政数据显著低估了住院成年人痴呆症的诊断,错过了大多数病例. 检测到的和错过的妄想病例都与死亡率和医疗保健成本的增加有关,这凸显了需要改进的检测方法的需要.
科学领域:
- 老年医学 老年医学
- 医院管理局 医院管理局
- 临床流行病学临床流行病学
背景情况:
- 痴呆症是住院成年人死亡和发病的普遍,可预防的原因.
- 精确确定妄想率是具有挑战性的,影响患者护理和资源分配.
研究的目的:
- 为了比较行政数据 (ICD-10-CA代码) 的准确性与回顾性图表审查,以识别医疗住院患者的妄想.
- 以 Delirium 检测方法来描述患者人口统计学,临床因素和结果的差异.
主要方法:
- 六家急症医院3881例内科住院病人的回顾性研究.
- 用国际疾病分类,第十次修订,加拿大适应 (ICD-10-CA) 代码和经过验证的图表审查方法确定 Delirium 状态.
- 群体之间的社会人口统计特征,临床因素,护理过程和结果的比较.
主要成果:
- 在25.7%的入院病例中,图表检查发现了妄想,而使用ICD-10-CA代码的仅为6.3%.
- 在ICD-10-CA代码中,妄检测的特异性高 (99.8%),但敏感性低 (24.1%).
- 患有妄想症的患者,无论检测方法如何,都经历了更高的住院死亡率和医疗费用中位数.
结论:
- 行政数据是特定的,但对于检测医院获得的妄想来说是非常不敏感的,错过了大多数病例.
- 确定的和错过的妄想病例都与增加的死亡率和医疗保健支出有关.
- 迫切需要改进的,常规的方法来准确地测量在医院环境中的妄想发病率.
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