验证用于检测重大出血事件的HES编码:ROBOT-ACS研究的见解
1Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK. liam.mullen@lhch.nhs.uk.
BMC medical research methodology
|February 20, 2025
概括
医院病例统计 (HES) ICD-10代码在识别重大出血事件方面表现不佳. 为了获得准确的心血管研究数据,需要进一步的询问或混合方法.
科学领域:
- 心血管研究的心血管研究.
- 医疗信息学 医疗信息学
- 临床结果研究研究的临床结果.
背景情况:
- 医院情节统计 (HES) 数据越来越多地用于临床结果报告.
- 国际疾病分类第十版 (ICD-10) 诊断代码对主要出血事件的性能基本上是未知的.
- 机器人-ACS研究提供了一个独特的数据集,用于评估ICD-10代码的准确性与判定出血事件.
研究的目的:
- 评估HES数据中的个人ICD-10诊断代码的准确性,以识别重大出血事件.
- 为了比较ICD-10代码的性能与传统判定出血事件的黄金标准.
- 评估HES数据在心血管研究中用于确定出血事件的有用性.
主要方法:
- 从ROBOT-ACS研究中对1172个HES记录进行了二次分析.
- 检查了含有出血或贫血代码的记录.
- 个人和分组ICD-10代码的积极预测值 (PPV) 针对213个被判定的主要出血而计算.
主要成果:
- 大多数ICD-10代码显示严重出血的阳性预测值 (PPV) 较差,一般低于50%.
- 与内出血相关的代码在单个代码类型中表现最好.
- 排除贫血代码将导致213个被判定出血事件中的26个失踪.
结论:
- 在没有进一步验证的情况下,HES数据中的诊断ICD-10代码在识别主要出血事件时表现不佳.
- 虽然敏感度可能足够,但在区分重大出血时的特异性是一个挑战.
- 未来使用HES数据进行心血管研究中的出血评估可能需要采用混合方法 (HES查加记录审查) 或使用HES数据重新定义显著出血.
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