The Use of International Classification of Diseases Codes to Identify Patients with Pancreatitis: A Systematic Review and Meta-analysis of Diagnostic Accuracy Studies

Abstract

BackgroundHospital discharge codes are increasingly used in gastroenterology research, but their accuracy in the setting of acute pancreatitis (AP) and chronic pancreatitis (CP), one of the most frequent digestive diseases, has never been assessed systematically. The aim was to conduct a systematic literature review and determine accuracy of diagnostic codes for AP and CP, as well as the effect of covariates.MethodsThree databases (Pubmed, EMBASE and Scopus) were searched by two independent reviewers for relevant studies that used International Classification of Disease (ICD) codes. Summary estimates of sensitivity, specificity and positive predictive value were obtained from bivariate random-effects regression models. Sensitivity and subgroup analyses according to recurrence of AP and age of the study population were performed.ResultsA total of 24 cohorts encompassing 18,106 patients were included. The pooled estimates of sensitivity and specificity of ICD codes for AP were 0.85 and 0.96, respectively. The pooled estimates of sensitivity and specificity of ICD codes for CP were 0.75 and 0.94, respectively. The positive predictive value of ICD codes was 0.71 for either AP or CP. It increased to 0.78 when applied to incident episode of AP only. The positive predictive value decreased to 0.68 when the ICD codes were applied to paediatric patients.ConclusionNearly three out of ten patients are misidentified as having either AP or CP with the indiscriminate use of ICD codes. Limiting the use of ICD codes to adult patients with incident episode of AP may improve identification of patients with pancreatitis in administrative databases.

Auditing the Accuracy of Medical Diagnostic Coding based on International Classification of Diseases, Tenth Revision

“…Numerous studies have been conducted on the accuracy of coding in other countries. The evaluation of the accuracy of diagnostic coding in the studies conducted by Xiao et al on chronic acute pancreatitis (10), Liu in patients with sarcoma (17), and Worfellan et al on patients with syncope (18) is not significantly different from the present study.…”

“…Numerous studies have been conducted on the quality and accuracy of coding which yielded contradictory results. Some of these findings pointed to poor coding quality, while some others demonstrated good results (8)(9)(10)(11)(12)(13)(14). In their study, Thomas et al1.…”

Time trends in incidence and prevalence of chronic pancreatitis: A 25‐year population‐based nationwide study

“…Of particular note, studies based on register data rather than individual case assessment may overestimate the incidence rate by 20-30% as the positive predictive value of a CP diagnosis using register data has been estimated to be 70-80%. 16,20 Prevalence estimates of CP have mostly been limited to studies based on non-population-based settings with relatively short observation periods. We observed the highest prevalence of CP reported to date in Europe (153.9 per 100,000 persons in 2016), which is considerably higher than prevalence estimates previously reported.…”

Pancreatitis, Pancreatic Cancer, and Their Metabolic Sequelae: Projected Burden to 2050

“…Fourth, the use of ICD codes for pancreatitis might have overestimated its actual incidence in this study. A meta-analysis of 24 cohorts suggested that the overall diagnostic accuracy of ICD codes for pancreatitis is suboptimal, with the pooled estimate of positive predictive value of ICD codes for AP being 71% ( 36 ). However, the estimate improves to 78% when the study population is constrained to incident AP in adults, which was the case in this study.…”