Evaluation of the ICD-10 system in coding revascularisation procedures in patients with peripheral arterial disease in England: a retrospective cohort study using national administrative and clinical databases

Birmpili, Panagiota; Atkins, Eleanor; Li, Qiuju; Johal, Amundeep S.; Waton, Sam; Williams, R; Pherwani, A.D.; Cromwell, David

doi:10.1016/j.eclinm.2022.101738

Cited by 11 publications

(11 citation statements)

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“…Second, it was not possible to account for the severity of PAD and other potentially relevant variables, such as smoking and ethnicity, as these are not well documented in the ICD-10 diagnosis codes used in HES. However, the selection of ICD-10 codes used to define the cohort and the side of the procedure were informed by a previous study 37 comparing coding between HES and NVR databases.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after minor lower limb amputation for peripheral arterial disease and diabetes: population-based cohort study

Birmpili

Johal

et al. 2023

British Journal of Surgery

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Background Patients with diabetes and peripheral arterial disease are at increased risk of minor amputation. The aim of study was to assess the rate of re-amputations and death after an initial minor amputation, and to identify associated risk factors. Methods Data on all patients aged 40 years and over with diabetes and/or peripheral arterial disease, who underwent minor amputation between January 2014 and December 2018, were extracted from Hospital Episode Statistics. Patients who had bilateral index procedures or an amputation in the 3 years before the study were excluded. Primary outcomes were ipsilateral major amputation and death after the index minor amputation. Secondary outcomes were ipsilateral minor re-amputations, and contralateral minor and major amputations. Results In this study of 22 118 patients, 16 808 (76.0 per cent) were men and 18 473 (83.5 per cent) had diabetes. At 1 year after minor amputation, the estimated ipsilateral major amputation rate was 10.7 (95 per cent c.i. 10.3 to 11.1) per cent. Factors associated with a higher risk of ipsilateral major amputation included male sex, severe frailty, diagnosis of gangrene, emergency admission, foot amputation (compared with toe amputation), and previous or concurrent revascularization. The estimated mortality rate was 17.2 (16.7 to 17.7) per cent at 1 year and 49.4 (48.6 to 50.1) per cent at 5 years after minor amputation. Older age, severe frailty, comorbidity, gangrene, and emergency admission were associated with a significantly higher mortality risk. Conclusion Minor amputations were associated with a high risk of major amputation and death. One in 10 patients had an ipsilateral major amputation within the first year after minor amputation and half had died by 5 years.

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Section: Discussionmentioning

confidence: 99%

Outcomes after minor lower limb amputation for peripheral arterial disease and diabetes: population-based cohort study

Birmpili

Johal

et al. 2023

British Journal of Surgery

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“…Zbog mogućnosti sustavno pogrešne klasifikacije među bolnicama u smislu odabira dijagnoza i radi veće kliničke utemeljenosti, dva liječnika specijalista, interventni radiolog iz Kliničke bolnice Dubrava i internist kardiolog iz Kliničkog bolničkog centra Zagreb, iz bolničkih informacijskih sustava navedenih ustanova odabrali su dijagnoze koje se primjenjuju u kodiranju PAB-a te interventnih i dijagnostičkih postupaka u takvih bolesnika. 14 Navedene su dijagnoze dopunjene dijagnozama koje su iskorištene u drugim istraživanjima. 15 U konačnici, iz Baze umrlih Hrvatskog zavoda za javno zdravstvo za razdoblje od 2011. do 2020. godine dobiveni su podatci po petogodišnjim dobnim skupinama od 0 do 85+, spolu i županijama za sljedeće dijagnoze 16,17 (tablica 1).…”

Section: Materijali I Metode Izvori Podatakaunclassified

“…Due to systemic misclassification bias between hospitals with regard to choosing the diagnosis and in order to achieve higher clinical reliability, two specialist physicians, namely an interventional radiologist from the Dubrava Clinical Hospital and an internist cardiologist from the University Hospital Centre Zagreb, were engaged to examine hospital information systems and choose the diagnoses that are applied in coding PAD as well as the interventional and diagnostic procedures used in these patients. 14 These diagnoses were supplemented by diagnoses used in other studies. 15 Finally, the Mortality Database of the Croatian Institute of Public Health was used to collect data for the period from 2011 to 2020, stratified by five-year age groups for patients between the ages of 0 and 85+, as well as by sex and by county (Table 1).…”

Section: Data Sourcesmentioning

confidence: 99%

Regional Differences in Standardized Mortality Rate Trends for Peripheral Artery Disease from 2011 to 2020 in the Republic of Croatia

Biloglav,

Medaković,

Vidović

et al. 2024

Cardiologia Croatica

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“…In particular, data on disease outcomes from population scale biobanks are only available through recorded ICD-10 billing codes or self-reported diagnosis [1][2][3] . While these datasets have provided invaluable insights into the genetic basis of disease, case ascertainment based solely on information available in the EHR or from self-reports can be biased by a multitude of factors including differences in how patients were billed 4 , differential diagnosis due to assessment by clinicians (non-specialist vs specialist) 5 , or differences in classification or diagnosis based on disease severity 6 .…”

Section: Introductionmentioning

confidence: 99%

Deep learning based phenotyping of medical images improves power for gene discovery of complex disease

Flynn

Javan

Lin³

et al. 2023

Preprint

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Electronic health records (EHRs) are often incomplete and inaccurate, reducing the power of genome-wide association studies (GWAS). Moreover, the variables within these records are often represented in binary codes, masking variation in disease severity among individuals. For some diseases, such as knee osteoarthritis (OA), radiographic assessment is the primary means of diagnosis and can be performed directly from medical images. In this work, we trained a deep learning model (DL-binary) to ascertain knee OA cases from anteroposterior (AP) dual-energy absorptiometry (DXA) scans and achieved clinician level performance. Applying this model across 29,257 individuals from the UK Biobank (UKB), we identified 2,603 (240%) more cases than currently diagnosed in the ICD-10 record. Individuals diagnosed as cases by DL-binary had higher rates of self-reported knee pain, knee pain for longer durations and with increased severity compared to control individuals. We trained another deep learning model to measure the minimum knee joint space width (mJSW), a quantitative phenotype linked to knee OA severity. Despite the DL-binary phenotype and mJSW being highly genetically correlated (92%), the heritability of mJSW was an order of magnitude greater than the ICD-10 code M17 or DL-binary phenotypes. In a GWAS run on mJSW, we identified 18 genome-wide significant loci, as opposed to 1 and 6 at the same sample size using either case-control (DL-binary and ICD-10 code M17) phenotype. This improved power also translated to better polygenic risk score (PRS) prediction for knee OA diagnosis in a holdout dataset of 371,686 individuals. We also show that reduced mJSW, but neither case-control phenotype is associated with increased risk of adult fractures, a leading cause of injury-related death in older individuals. For diseases with radiographic diagnosis, our results demonstrate the enormous potential for using deep learning to phenotype at biobank scale, both for improving power for gene discovery and for epidemiological analysis.

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Evaluation of the ICD-10 system in coding revascularisation procedures in patients with peripheral arterial disease in England: a retrospective cohort study using national administrative and clinical databases

Cited by 11 publications

References 11 publications

Outcomes after minor lower limb amputation for peripheral arterial disease and diabetes: population-based cohort study

Outcomes after minor lower limb amputation for peripheral arterial disease and diabetes: population-based cohort study

Regional Differences in Standardized Mortality Rate Trends for Peripheral Artery Disease from 2011 to 2020 in the Republic of Croatia

Deep learning based phenotyping of medical images improves power for gene discovery of complex disease

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