诊断代码的外部验证以识别儿科精神卫生急诊室对侵略的访问
Julia H Wnorowska1, Alexis Harmon2, Doug Lorenz3
1Northwestern University Feinberg School of Medicine.
Pediatric emergency care
|February 9, 2026
概括
一项研究发现,尽管特异性很高,但9个计费诊断代码对儿童急诊室 (ED) 访问的兴奋和侵略性进行了不良识别. 为了准确的识别,可能需要更先进的方法,例如自然语言处理.
科学领域:
- 儿科急救医学 儿科急救医学
- 心理健康信息学心理健康信息学
- 临床诊断 临床诊断 临床诊断
背景情况:
- 准确识别儿科急诊室 (ED) 遇到涉及激动和侵略的情况,对于适当的护理和资源分配至关重要.
- 当前的诊断编码系统可能无法完全捕捉到这些行为健康事件的复杂性.
- 需要对现有的计费代码进行外部验证,以评估它们在识别这些特定儿科ED访问中的实用性.
研究的目的:
- 在外部验证一组9国际疾病分类,第十次修订,临床修改 (ICD-10-CM) 计费诊断代码.
- 确定这些代码在识别儿科ED遇到动荡和侵略时的敏感性和特异性.
- 将计费代码的诊断准确性与结构化电子健康记录 (EHR) 审查进行比较.
主要方法:
- 一个回顾性,横截面的诊断准确性研究是使用儿科ED.的EHR数据进行的.
- 这项研究包括6至18岁儿童的心理健康遭遇.
- 索引测试涉及确定9个特定的与侵略有关的诊断代码,而参考标准是结构化的EHR审查,以确认煽动/侵略是访问的原因.
主要成果:
- 在855起儿科心理健康遭遇中,通过电子健康记录审查确认了118起 (14%),涉及激动/攻击.
- 在9个诊断码中,只有62次 (7%),发现了激动/侵略.
- 这些代码的灵敏度为40%,特异性为98%,具有76%的积极预测值和91%的负预测值.
结论:
- 外部验证显示,这组9个计费诊断代码的灵敏度很低,但对于识别涉及激动/攻击的儿科ED访问的特异性很好.
- 这些发现表明,这些计费代码不足以准确地捕捉该人口中所有动荡和侵略的情况.
- 新的方法,如临床笔记的自然语言处理 (NLP),可能需要提高儿科ED访问与激动/攻击的准确识别.
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