Icd 10 Code for Family History of Ruptured Aneurysm

Clin Epidemiol. 2021; xiii: 43–51.

Validation of ICD-10-CM Diagnosis Codes for Identification of Patients with Astute Hemorrhagic Stroke in a National Health Insurance Claims Database

Meng-Tsang Hsieh,^{# 1, two, 3, *} Kuo-Chang Huang,^{# four, *} Cheng-Yang Hsieh,^{v, 6} Tzu-Tung Tsai,¹ Li-Ching Chen,^one and Sheng-Feng Sung^{vii, 8, 9}

Meng-Tsang Hsieh

¹Stroke Eye and Department of Neurology, E-Da Infirmary, Kaohsiung, Taiwan

ⁱⁱSchool of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan

³Institute of Clinical Medicine, Higher of Medicine, National Cheng Kung University, Tainan, Taiwan

Kuo-Chang Huang

⁴Division of Neurosurgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan

Cheng-Yang Hsieh

^fiveDepartment of Neurology, Tainan Sin Lau Infirmary, Tainan, Taiwan

⁶School of Chemist's, Found of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan

Tzu-Tung Tsai

^aneStroke Center and Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan

Li-Ching Chen

¹Stroke Eye and Department of Neurology, Due east-Da Hospital, Kaohsiung, Taiwan

Sheng-Feng Sung

⁷Division of Neurology, Section of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Infirmary, Chiayi Metropolis, Taiwan

⁸Department of Information Management and Institute of Healthcare Data Management, National Chung Cheng Academy, Chiayi County, Taiwan

⁹Department of Nursing, Min-Hwei Inferior College of Wellness Care Management, Tainan, Taiwan

Received 2022 Oct 24; Accustomed 2022 December 30.

Abstract

Purpose

The performance of the International Nomenclature of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for identifying acute hemorrhagic stroke in Taiwan's National Health Insurance claims database has non been assessed. This study aimed to construct and validate the case definitions for acute hemorrhagic stroke based on ICD-10-CM diagnostic codes.

Patients and Methods

From January 2022 to December 2019, all inpatient records with ICD-10-CM code of I60 or I61 in any field of the discharge diagnoses were retrieved from the hospitalization claims data and all hospitalizations with a final diagnosis of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH) were identified from the stroke registry databases. The clinical diagnosis in the stroke registry was treated as the reference standard. For hospitalizations non recorded in the stroke registry, manual review of the medical records and images was washed to ascertain the diagnosis. The positive predictive value (PPV) and sensitivity of various case definitions for astute hemorrhagic stroke were estimated.

Results

Amidst the 983 hospitalizations, 860, 111, and 12 were determined to exist true-positive, fake-positive, and fake-negative episodes of acute hemorrhagic stroke, respectively. The PPV and sensitivity of the ICD-10-CM codes of I60 or I61 for identifying astute hemorrhagic stroke were 88.half-dozen% and 98.vi%, respectively. The PPV increased to 98.2%, whereas the sensitivity decreased to 93.one% when astute hemorrhagic stroke was divers as hospitalizations in which the master diagnosis field contained I60 or I61. Hemorrhagic transformation of ischemic stroke and concomitant cerebrovascular diseases other than SAH or ICH were the main reasons for a false-positive and false-negative diagnosis of acute hemorrhagic stroke, respectively.

Conclusion

This written report demonstrated the performance of ICD-10-CM codes for identifying acute hemorrhagic stroke and may offer a reference for time to come claims-based stroke studies.

Keywords: authoritative claims information, diagnosis, ICD-10-CM, hemorrhagic stroke

Introduction

Hemorrhagic stroke, including nontraumatic subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), is the second near mutual type of stroke, with a global lifetime adventure of viii.six% amongst adults aged over 25 years.^one Despite a worldwide decline in death rates from all kinds of stroke since 1990, hemorrhagic stroke accounts for the greatest burden of stroke among adults aged between 20 and 64 years,^two particularly in the low- and heart-income countries.ⁱⁱⁱ Meanwhile, even in the high-income countries, either early or long-term instance-fatality rates due to ICH have non ever improved over the past decades.^{4 , five} Therefore, more clinical inquiry is needed to optimize the treatment and thereby improve the outcomes of patients with hemorrhagic stroke.

Administrative claims information, which are derived from electronic data collected past health-intendance providers and insurers for the purpose of health-intendance direction, take nowadays provided an affordable and efficient style in conducting research on stroke⁶ or other cardiovascular diseases.⁷ For instance, Taiwan'south National Health Insurance (NHI) claims database, i of the largest comprehensive administrative claims databases in the world,⁸ has been widely used in stroke research. A bibliometric assay found that stroke was the second about mutual inquiry topic in studies using this database.⁹ Still, most of the stroke studies have focused on ischemic stroke rather than hemorrhagic stroke.^nine A potential explanation for this may be that researchers are less confident in performing research on hemorrhagic stroke because dissimilar an ischemic stroke, the validity of the diagnosis codes for ascertaining hemorrhagic stroke has never been assessed in Taiwan's NHI claims database.⁸

Therefore, this report aimed to construct and validate case definitions for hemorrhagic stroke based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-x-CM) codes using claims data from ii major stroke centers in Taiwan.

Patients and Methods

Study Settings

This study was conducted in the two NHI-contracted hospitals in southern Taiwan: the Ditmanson Medical Foundation Chia-Yi Christian Infirmary, a regional teaching hospital with approximately 650 stroke admissions annually, and the Due east-Da Hospital, a would-be medical eye with approximately k stroke admissions annually. The stroke centers of both hospitals have participated in the Taiwan Stroke Registry (TSR) Plan¹⁰ for more than a decade, and their quality of stroke care is certified by the Articulation Committee of Taiwan. The study protocol was independently canonical by the Institutional Review Lath of the Ditmanson Medical Foundation Chia-Yi Christian Hospital (IRB2020118) and the Institutional Review Board of the E-Da Hospital (EMRP-109-013). The requirement for informed consent was waived due to the retrospective design. The study data were kept with confidentiality to ensure the privacy of the study participants. This study was conducted in accordance with the Annunciation of Helsinki.

Data Sources and Record Linkage

This study used stroke registry information and administrative claims data from both hospitals. The stroke registry of each hospital prospectively registered sequent patients hospitalized for stroke within 10 days of symptom onset co-ordinate to the design of the TSR.¹⁰ Patient demographics, comorbidities, personal and medical history, stroke severity every bit assessed by the National Institutes of Health Stroke Scale, treatments received, hospital form, last diagnoses, and functional status as assessed using the modified Rankin Scale were nerveless. The hospitalization claims data reported to the Administration of NHI were retrieved from the hospital information organisation. Both data sources were linked through patients' unique identifier and the date of admission.

Written report Sample

Patients discharged betwixt January 2022 and December 2022 with a final diagnosis of acute hemorrhagic stroke, including SAH and ICH, were identified from the stroke registry. Even though Taiwan switched to ICD-10-CM coding in 2016, this study period was chosen since the E-Da Hospital did not enroll all patients hospitalized for stroke into the stroke registry before January 2018. Those with an in-infirmary stroke were retained. Patients with traumatic intracranial hemorrhage were excluded from the study, except those cases with concomitant acute hemorrhagic stroke and traumatic intracranial hemorrhage. Patients with missing information regarding appointment of birth, sex, or personal identifier were also excluded from the report. Multiple hospitalizations for the aforementioned stroke episode were combined into a single hospitalization. Conversely, multiple hospitalizations for the same patient due to different stroke episodes were counted as individual hospitalizations. Similarly, all patients discharged during the same period with an ICD-x-CM diagnosis lawmaking of I60 or I61 in any field of the discharge diagnoses were identified from the hospitalization claims data. Hospitalization records from either data sources were merged to form the study sample (Effigy 1A).

Process of case ascertainment (A) and calculation of the PPV and sensitivity (B).

Abbreviations: AHS, astute hemorrhagic stroke; FN, faux negative; FP, false positive; ICD-ten-CM, International Nomenclature of Diseases, 10th Revision, Clinical Modification; ICH, intracerebral hemorrhage; Neg, negative; Pos, positive; PPV, positive predictive value; SAH, subarachnoid hemorrhage; TN, true negative; TP, true positive.

Ascertainment of Astute Hemorrhagic Stroke

Effigy 1A shows the procedure of example ascertainment. According to the TSR programme,¹⁰ SAH was defined as

characteristic clinical manifestations of neurologic deficit, usually with sudden onset of astringent headache and either subarachnoid blood on encephalon computed tomography or/and not-traumatic bloody (or xanthochromic) cerebrospinal fluid with or without confirmation of the beingness of aneurysm by magnetic resonance angiography or conventional cerebral angiography.

ICH was defined equally

non-traumatic abrupt onset of symptoms with relevant focal neurological deficit with or without headache or altered level of consciousness with a focal collection of blood within the brain parenchyma on computed tomography or magnetic resonance imaging that was not a hemorrhagic conversion of a cerebral infarction.

Cases of SAH or ICH must meet these criteria earlier existence entered the stroke registry.

The clinical diagnosis in the stroke registry was treated as the reference standard because the TSR used several quality assurance processes to ensure data quality, including web-based examination and on-site auditing.^ten Whatever hospitalization in the claims data that could exist successfully linked to one of the hospitalizations in the registry data was considered a truthful episode of acute hemorrhagic stroke. For hospitalizations in the claims data that could not be linked to whatever of the hospitalizations in the registry information, their electronic medical records and brain images were reviewed separately in each hospital by an experienced stroke neurologist (SFS in the Chia-Yi Christian Infirmary and MTH in the Eastward-Da Hospital) to determine whether these were true episodes of acute hemorrhagic stroke.

For hospitalizations determined not to be true episodes of acute hemorrhagic stroke, the reasons were further categorized into the following groups: (1) hemorrhagic transformation of acute ischemic stroke (AIS); (2) subacute, chronic, or remote SAH or ICH (presenting more than 10 days after symptom onset); (iii) subdural hemorrhage; (four) a tentative diagnosis of acute hemorrhagic stroke, which was later excluded afterwards clinical evaluation and imaging studies; and (v) other diagnoses (eg, brain tumor with hemorrhage and neonatal intracranial hemorrhage).

Data Analyses

This study examined various case definitions for identifying cases of acute hemorrhagic stroke including (1) ICD-10-CM code of I60 or I61 every bit the primary diagnosis; (2) I60 or I61 as the primary or first secondary diagnosis; (3) I60 or I61 as the primary, kickoff secondary, or 2d secondary diagnosis; and (4) I60 or I61 in any field of the diagnosis. Similarly, case definitions for identifying subtypes of acute hemorrhagic stroke were investigated, including the ICD-ten-CM codes of I60 and I61 for identifying cases of SAH and ICH, respectively.

The positive predictive value (PPV) was defined every bit the proportion of hospitalization records with an ICD-10-CM coded diagnosis for which the hospitalization was confirmed to be a true episode of acute hemorrhagic stroke (Figure 1B). Sensitivity was divers every bit the proportion of hospitalizations due to acute hemorrhagic stroke matching the ICD-10-CM coded diagnosis in the administrative claims data (Figure 1B). PPVs and sensitivities were calculated and their 95% confidence intervals (CIs) for binomial proportions were estimated using the Clopper–Pearson verbal method. For subgroup analysis, whether patient age, sex activity, and medical comorbidities, including hypertension and diabetes, would affect the validity of ICD-10-CM coding in the claims data was additionally examined. PPVs and sensitivities betwixt stroke subtypes and subgroups were compared using the chi-foursquare exam. A two-tailed p value of <0.05 was considered to be statistically significant. Data analyses were performed using Stata 15.1 (StataCorp, College Station, Texas).

Results

From Jan 2022 to Dec 2019, a full of 806 singled-out hospitalizations due to acute hemorrhagic stroke were identified from the registry data. All hospitalization records contained valid data regarding date of nascence, sex, and personal identifier and were thus eligible for record linkage. During the same period, 971 distinct hospitalizations with an ICD-10-CM code of I60 or I61 in whatsoever field of the discharge diagnoses were identified from the hospitalization claims data. Amidst them, 161 and 865 hospitalizations were coded with I60 and I61, respectively; that is, 55 hospitalizations were coded with both I60 and I61. The linking of hospitalization records between both data sources (Effigy 1A) resulted in 794 successfully linked hospitalizations, which were regarded as truthful-positive episodes of acute hemorrhagic stroke. Amid the remaining 177 hospitalizations in the claims data that could not be linked to any record in the registry data, 66 were considered true-positive episodes whereas 111 were adamant to be false-positive episodes of acute hemorrhagic stroke after manual review. In addition, 12 hospitalizations from the registry data could not be identified in the claims data and were thus regarded as imitation-negative episodes of acute hemorrhagic stroke. Consequently, the PPV and sensitivity of ICD-10-CM diagnosis of acute hemorrhagic stroke were 88.6% (95% CI, 86.iv–90.five%) and 98.6% (95% CI, 97.half dozen–99.3%).

Table 1 shows the validity of various case definitions to identify cases of acute hemorrhagic stroke as a whole or cases of SAH or ICH separately. The example definition of using the ICD-10-CM lawmaking of I60 or I61 every bit the primary diagnosis to identify acute hemorrhagic stroke yielded a PPV and sensitivity of 98.2% and 93.1%, respectively. This case definition missed a proportion of acute hemorrhagic stroke hospitalizations because conditions other than hemorrhagic stroke were coded as the primary diagnosis. Table 2 summarizes the reasons for these missed cases. Among them, the well-nigh common reason was concomitant cerebrovascular diseases other than SAH or ICH (n = 22), followed by infection or inflammation (n = 12). In contrast, when acute hemorrhagic stroke was divers as I60 or I61 in the first three fields of discharge diagnoses, the sensitivity increased to 98.2% with a drop of PPV from 98.two% to 91.6%. When ICD-x-CM codes were used to place cases of SAH or ICH lone, the values of PPV were lower for SAH than for ICH without reaching statistical significance (p values ranging from 0.053 to 0.314). The sensitivity values for SAH were significantly lower than those for ICH (p values ranging from <0.001 to 0.017). The sensitivity was as low as 82.0% when I60 every bit the primary diagnoses was used to ascertain the diagnosis of SAH.

Table i

Validity of Various Case Definitions for Identifying Cases of Astute Hemorrhagic Stroke, SAH, and ICH

Case Definitions	TP	FP	FN	PPV (95% CI), %	Sen (95% CI), %
Acute hemorrhagic stroke (SAH or ICH)
I60 or I61 every bit primary diagnosis	812	15	sixty	98.ii (97.0–99.0)	93.one (91.2–94.vii)
I60 or I61 as master or showtime secondary diagnosis	843	68	29	92.5 (xc.6–94.two)	96.7 (95.three–97.eight)
I60 or I61 every bit primary, starting time secondary, or 2d secondary diagnosis	856	79	16	91.half-dozen (89.half dozen–93.3)	98.ii (97.0–98.9)
I60 or I61 in any field of diagnosis	860	111	12	88.half-dozen (86.4–xc.5)	98.6 (97.six–99.3)
SAH
I60 as primary diagnosis	123	7	27	94.vi (89.2–97.8)	82.0 (74.nine–87.eight)
I60 as primary or first secondary diagnosis	135	xiv	15	90.half-dozen (84.vii–94.eight)	90.0 (84.0–94.3)
I60 as master, offset secondary, or second secondary diagnosis	141	16	nine	89.8 (84.0–94.one)	94.0 (88.nine–97.2)
I60 in any field of diagnosis	142	19	8	88.two (82.2–92.7)	94.7 (89.viii–97.7)
ICH
I61 as chief diagnosis	708	17	83	97.7 (96.3–98.6)	89.5 (87.2–91.6)
I61 every bit primary or showtime secondary diagnosis	761	48	30	94.1 (92.2–95.six)	96.2 (94.6–97.four)
I61 as main, first secondary, or 2nd secondary diagnosis	772	56	19	93.2 (91.three–94.9)	97.vi (96.3–98.five)
I61 in any field of diagnosis	785	80	6	90.8 (88.6–92.6)	99.2 (98.4–99.7)

Table 2

Reasons for Faux-Negative Episodes of Acute Hemorrhagic Stroke When I60 or I61 equally the Primary Diagnosis Was Used to Identify Acute Hemorrhagic Stroke (N = lx)

Reason	n
Concomitant cerebrovascular diseases other than SAH or ICHa	22
Infection or inflammation	12
Malignancy	vii
Concomitant traumatic accident	6
Consciousness change	2
Extracranial aneurysm, dissection, or injury	2
Heart diseases	2
Miscellaneousb	7

Table 3 shows the reasons for the false-positive episodes of acute hemorrhagic stroke. More than half of the episodes were due to hemorrhagic transformation of AIS. Around ane-fifth of them were due to subacute, chronic, or remote SAH or ICH. Another ane-fifth of the false-positive episodes received other diagnoses (Table 4) merely were miscoded as an acute hemorrhagic stroke. Of the 12 false-negative episodes of acute hemorrhagic stroke, iv were coded as I67.1 (cerebral aneurysm, non-ruptured), 1 was coded as I62.9 (nontraumatic intracranial hemorrhage, unspecified), and 7 had diagnoses codes unrelated to cerebrovascular diseases (from I60 to I61).

Tabular array 3

Reasons for False-Positive Episodes of Acute Hemorrhagic Stroke (N = 111)

Reason	n (%)
Hemorrhagic transformation of AIS	59 (53.2)
Subacute, chronic, or remote SAH or ICH	24 (21.vi)
Subdural hemorrhage	1 (0.9)
Astute hemorrhagic stroke as a tentative diagnosis only excluded by studies	3 (two.seven)
Other diagnoses miscoded as acute hemorrhagic stroke	24 (21.6)

Table 4

Concluding Diagnoses of Miscoded Cases (N = 24)

Diagnosis	n
Brain tumor with hemorrhage	12
Neonatal intracranial hemorrhage	3
Intracranial aneurysm without hemorrhage	ii
Traumatic intracranial hemorrhage	1
Cognitive venous thrombosis with hemorrhagic infarction	1
AIS	one
Brain abscess	one
Subdural empyema	1
Ventriculomegaly	1
Ventriculitis	ane

Table 5 shows the results for the subgroup analyses that compared the PPVs and sensitivities between subgroups co-ordinate to patient age, sexual practice, and the presence of hypertension or diabetes. The PPV in the young subgroup (91.vii%) was significantly higher than that in the elderly group (84.nine%), while the sensitivities were comparable between subgroups. The PPV and sensitivity for patients without hypertension were significantly lower than for those with hypertension.

Table 5

Subgroup Analyses According to Patient Historic period, Sexual practice, and the Presence of Hypertension or Diabetes

Subgroup	TP	FP	FN	PPV (95% CI), %	P	Sen (95% CI), %	P
Age					0.001		0.887
Elderly (≥65 years)	376	67	5	84.ix (81.2–88.ane)		98.seven (97.0–99.six)
Immature (<65 years)	484	44	7	91.7 (89.0–93.9)		98.6 (97.1–99.four)
Sex					0.951		0.352
Male	532	69	9	88.5 (85.7–91.0)		98.three (96.9–99.ii)
Female person	328	42	iii	88.6 (85.0–91.vii)		99.1 (97.4–99.8)
Hypertension					<0.001		<0.001
Yes	672	67	three	90.9 (88.6–92.9)		99.vi (98.seven–99.9)
No	188	44	ix	81.0 (75.4–85.ix)		95.iv (91.5–97.nine)
Diabetes					0.441		0.130
Yep	241	35	i	87.iii (82.8–91.0)		99.6 (97.7–100.0)
No	619	76	11	89.1 (86.5–91.3)		98.iii (96.9–99.1)

Give-and-take

This study assessed the validity of diverse example definitions of ICD-10-CM diagnoses of acute hemorrhagic stroke as a whole, SAH alone, or ICH alone. The PPVs for SAH or ICH were generally comparable to those reported by like studies that examined the validity of ICD codes for diagnosing SAH or ICH in other administrative databases.^11–fifteen According to a systematic review of validation studies of ICD codes for acute stroke, the PPVs for SAH and ICH were ≥93% and ≥89%, respectively, in at to the lowest degree one-half of the studies.¹¹ In more than contempo studies from the Czech Republic,¹² Republic of korea,¹³ Kingdom of denmark,¹⁴ and Australia,¹⁵ using the primary diagnosis code only, the PPVs ranged from 85% to 91% and sensitivities from 73% to xc% for SAH. For ICH, the PPVs ranged from 75% to 92% and sensitivities from sixty% to 85%. However, due to the variation in study settings and reference standards used across studies, a straight comparing of results may be difficult.

This study suggested that, when merely the primary diagnosis code was used, the PPV was maximized at the toll of low sensitivity. As the number of diagnosis code fields used for example ascertainment increased, the sensitivity increased as the PPV decreased. The study findings were similar to our previous report that examined the performance of ICD-ten-CM codes for identifying AIS in Taiwan'due south NHI claims database.¹⁶ Nevertheless, discussing the potential implications for researchers interested in hemorrhagic stroke using this claims database is worthwhile. In contrast to AIS, astute hemorrhagic stroke mainly encompasses SAH (I60) and ICH (I61). Among the report sample, more than five% (55/971) of the hospitalizations due to acute hemorrhagic stroke had both SAH and ICH listed in the belch diagnoses. The co-occurrence of both conditions forced each condition to compete for the master diagnosis field, thereby explaining why the PPV and sensitivity using either I60 or I61 as the primary diagnosis to identify astute hemorrhagic stroke were higher than those using I60 equally the primary diagnosis to place SAH or using I61 as the master diagnosis to place ICH. Besides, since SAH is usually associated with cerebral aneurysms, I60 was less likely to be coded as the principal diagnosis when the amount of SAH was small and cognitive aneurysms were considered the chief clinical problem. Such a coding convention might atomic number 82 to a relatively low sensitivity (82.0%) when using I60 as the chief diagnosis to identify SAH.

More than half of the false-positive episodes (53.2%) for the case definition using I60 or I61 in any diagnosis field to identify astute hemorrhagic stroke were attributed to the hemorrhagic transformation of AIS. As the rate of thrombolytic therapy for AIS increases over the years,^{17 , xviii} hemorrhagic transformation of AIS will become more than prevalent and may warrant more claims database studies to provide real-globe evidence of illness brunt and treatment patterns.¹⁷ Nevertheless, no existing ICD-10-CM codes that can be used to code this status were establish. Whether hemorrhagic transformation of AIS tin can be identified from Taiwan's NHI claims database by the coexistence of the ICD-ten-CM codes of acute hemorrhagic stroke and AIS in the belch diagnoses awaits further investigation. For now, the accuracy of using ICD codes to identify hemorrhagic transformation of AIS remains questionable.^{19 , 20}

The case definitions tested in this study showed different tradeoffs between the PPV and sensitivity, as shown in a report that investigated various case definitions for stroke in Korean NHI claims data.^xiii In this regard, the report results presented in Table one may help researchers choose an ICD-x-CM coding definition that suits their inquiry purposes to identify an acute hemorrhagic stroke. For studies where a validated method for identifying all patients with acute hemorrhagic stroke, SAH, or ICH is crucial, the example definitions that apply ICD-10-CM codes in the first three diagnosis fields to identify the corresponding condition are highly recommended. Despite the expense of a drop in PPV values as compared to those case definitions that utilise only the primary diagnosis, these case definitions had a much higher sensitivity, which is beneficial for enhancing report inclusiveness and ascertaining exposures.²¹ Conversely, example definitions with high PPV that employ only the main diagnosis may be more than appropriate when information technology is of import for researchers to identify a "pure" cohort of patients with astute hemorrhagic stroke, SAH, or ICH that need not be representative of every patient with that status.²¹

Of note, the PPV of ICD coding for acute hemorrhagic stroke in the young subgroup was significantly higher (91.seven% vs 84.ix%) than that in the elderly group. A previous study on ICD coding for AIS reported a similar finding, which may be explained by the college prevalence of comorbidities amid the elderly.¹⁶ Compared to young adults, elderly subjects comport a higher gamble of hemorrhagic transformation of AIS,^{22 , 23} and a higher risk of brain tumor.²⁴ Furthermore, elderly people are naturally more likely to have chronic or remote hemorrhagic stroke. All of the above conditions might exist erroneously coded as acute hemorrhagic stroke (Tables 3 and ​ 4), leading to a higher false-positive rate for acute hemorrhagic stroke in the elderly subgroup. Besides, the PPV and sensitivity for patients without hypertension were significantly lower than for those with hypertension. Upward to eighty% of cases of ICH have hypertension,^iv which is probably the well-nigh prevalent and relevant risk gene for acute hemorrhagic stroke. Therefore, for patients without hypertension, haemorrhage in the brain may be more likely due to etiologies other than acute hemorrhagic stroke (eg, brain tumor with hemorrhage).

This report has several limitations worth mentioning. First, the written report blueprint did not let us to discover patients with acute hemorrhagic stroke who had been missed by both the stroke registry and ICD codes (false negatives). For example, if only ICD codes are used to identify patients for inclusion in the stroke registry, the estimate of imitation negatives volition be low. In fact, patients with stroke were screened using a computer algorithm using both ICD-10 codes and gratuitous-text diagnosis fields in the electronic medical records, followed by a transmission review by stroke case managers. Therefore, the underestimation of fake negatives is probable to be modest in this report. Second, information on the proportion of patients who did not have an acute hemorrhagic stroke and were not coded equally such (true negatives) were non available. Therefore, providing the specificity and the negative predictive value is impossible. Third, information from the stroke registry databases were used as the reference standard for the diagnosis of hemorrhagic stroke. Although the registry data were collected by trained study nurses following the standard protocol of the TSR and the data quality was audited,^x verifying the accurateness of the stroke registry may even so be necessary past performing a cross-sectional report. Fourth, hospitalizations that could not be identified in the registry information were manually reviewed by simply ane stroke neurologist at each site. Finally, the report sample comes from only two stroke centers. They may not be representative of all hospitals contracted with Taiwan'southward NHI since the validity of diagnostic codes may vary across hospitals.^thirteen Further multicenter validation studies may be needed to confirm or compare these findings.

Conclusion

This validation study assessed the validity of various ICD-10-CM definitions for acute hemorrhagic stroke including SAH and ICH in Taiwan's NHI claims database using combined data from two centers. The sensitivity and PPV values varied across dissimilar instance definitions; therefore, researchers should consider the tradeoffs between the accuracy measures. Thus, the results of this study may aid futurity studies apply advisable case definitions for astute hemorrhagic stroke that are nigh suited to their written report purposes.

Acknowledgments

This research was funded by the E-Da Infirmary (grant number EDAHP107021) and the Ditmanson Medical Foundation Chia-Yi Christian Hospital Enquiry Program (grant number R 109-37-1). The funders of the research had no role in the design and conduct of the written report, interpretation of the data, or determination to submit for publication. The authors would like to give thanks Ms Li-Ying Sung for English language language editing and Enago for the English language language review.

Disclosure

The authors report no conflicts of interest in this piece of work.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813455/

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