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

Hsieh, Meng-Tsang; Hsieh, Cheng‐Yang; Tsai, Tzu-Tung; Chen, Li-Ching; Sung, Sheng Feng

doi:10.2147/clep.s288518

Cited by 35 publications

(38 citation statements)

References 24 publications

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“…However, it is important to understand the limitations of administrative databases, as these secondary data are not collected for research purposes [51][52][53][54][55]. First, a particular disadvantage of administrative data is the inability to ascertain baseline stroke severity, which is an important predictor of short-and long-term outcome and therefore remains as an important residual confounder variable [51,52,54].…”

Section: Discussionmentioning

confidence: 99%

“…In Taiwan’s National Health Insurance database, compared with a stroke registry, the sensitivity for acute HS was 93.1% for hospitalizations in which the primary diagnosis field contained ICD10 codes I60 or I61 [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hsieh et al concluded that case definitions with high PPV that use only the primary diagnosis may be more appropriate when it is important for researchers to identify a “pure” cohort of patients with acute HS [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

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Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18

López‐de‐Andrés

Jiménez‐García

Hernández‐Barrera

et al. 2021

Cardiovasc Diabetol

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Background To analyze incidence, use of therapeutic procedures, use of oral anticoagulants (OACs) and antiplatelet agents prior to hospitalization, and in-hospital outcomes among patients who were hospitalized with hemorrhagic stroke (HS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016–2018) and to assess the role of sex differences among those with T2DM. Methods Using the Spanish National Hospital Discharge Database we estimated the incidence of HS hospitalizations in men and women aged ≥ 35 years with and without T2DM. Propensity score matching (PSM) was used to compare population subgroups according to sex and the presence of T2DM. Results HS was coded in 31,425 men and 24,975 women, of whom 11,915 (21.12%) had T2DM. The adjusted incidence of HS was significantly higher in patients with T2DM (both sexes) than in non-T2DM individuals (IRR 1.15; 95% CI 1.12–1.17). The incidence of HS was higher in men with T2DM than in T2DM women (adjusted IRR 1.60; 95% CI 1.57–1.63). After PSM, men and women with T2DM have significantly less frequently received decompressive craniectomy than those without T2DM. In-hospital mortality (IHM) was higher among T2DM women than matched non-T2DM women (32.89% vs 30.83%; p = 0.037), with no differences among men. Decompressive craniectomy was significantly more common in men than in matched women with T2DM (5.81% vs. 3.33%; p < 0.001). IHM was higher among T2DM women than T2DM men (32.89% vs. 28.28%; p < 0.001). After adjusting for confounders with multivariable logistic regression, women with T2DM had a 18% higher mortality risk than T2DM men (OR 1.18; 95% CI 1.07–1.29). Use of OACs and antiplatelet agents prior to hospitalization were associated to higher IHM in men and women with and without T2DM. Conclusions T2DM is associated with a higher incidence of HS and with less frequent use of decompressive craniectomy in both sexes, but with higher IHM only among women. Sex differences were detected in T2DM patients who had experienced HS, with higher incidence rates, more frequent decompressive craniectomy, and lower IHM in men than in women.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18

López‐de‐Andrés

Jiménez‐García

Hernández‐Barrera

et al. 2021

Cardiovasc Diabetol

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“…Restricting ICD-10-CM codes to the primary diagnosis or adding anticoagulants in case definitions improved the PPV to almost 100%, but at the expense of much fewer cases of identified CVST. In contrast to acute ischemic stroke 15 and hemorrhagic stroke, 13 there were few prior studies on the PPV of ICD-10-CM codes for CVST. In a recent validation study conducted in the UK, most of the ascertained CVST cases (n = 60) were coded with G08 (90%), rather than I636 (1.7%) or I676 (1.7%).…”

Section: Discussionmentioning

confidence: 99%

“…We chose I629 to identify possible cases of CVST because some of them might present with intracerebral hemorrhage, according to our prior study. 13 If a patient had multiple hospitalization episodes with aforementioned discharge diagnoses during the study period, only the first hospitalization was retrieved for analysis.…”

Section: Methodsmentioning

confidence: 99%

Positive Predictive Value of ICD-10 Codes for Cerebral Venous Sinus Thrombosis in Taiwan’s National Health Insurance Claims Database

Liao¹,

Shao²,

Lai³

et al. 2022

CLEP

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Objective: This study aims to determine the positive predictive value (PPV) of case definitions for cerebral venous sinus thrombosis (CVST) in Taiwan's National Health Insurance claims database based on the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnostic codes. Study Design and Setting: Inpatient records with ICD-10-CM codes of G08, I629, I636, or I676 were retrieved from the claims data of all hospital branches of Chang Gung Medical Foundation. Manual review of the medical records and images was performed in order to ascertain the diagnosis. The PPV of various case definitions for CVST was estimated. Results: Of the 380 hospitalizations, 166 and 214 were determined to be true-positive and false-positive episodes of acute CVST, respectively. The PPV of the ICD-10-CM codes of G08, I629, I636, and I676 was 88.2%, 2.0%, 100.0%, and 91.3%, respectively. The PPV generally increased when acute CVST was defined as a primary diagnosis or as ICD-10-CM codes plus anticoagulant use. Miscoding in other conditions, tentative diagnosis, and remote episode of CVST were determined as the main reasons for false-positive diagnosis of acute CVST. Conclusion:This study determined the PPV of ICD-10-CM codes for identifying CVST, which may offer a reference for future claims-based research.

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Risk of Bleeding Following Non–Vitamin K Antagonist Oral Anticoagulant Use in Patients With Acute Ischemic Stroke Treated With Alteplase

Tsai,

Liu,

Huang

et al. 2024

JAMA Intern Med

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ImportanceCurrent guidelines advise against intravenous alteplase therapy for treatment of acute ischemic stroke in patients previously treated with non–vitamin K antagonist oral anticoagulants (NOACs).ObjectiveTo evaluate the risk of bleeding and mortality after alteplase treatment for acute ischemic stroke among patients treated with NOACs compared to those not treated with NOACs.Design, Setting, and ParticipantsThis nationwide, population-based cohort study was conducted in Taiwan using data from Taiwan’s National Health Insurance Research Database from January 2011 through November 2020 and included 7483 patients treated with alteplase for acute ischemic stroke. A meta-analysis incorporating the results of the study with those of previous studies was performed, and the review protocol was prospectively registered with PROSPERO.ExposuresNOAC treatment within 2 days prior to stroke, compared to either no anticoagulant treatment or warfarin treatment.Main Outcomes and MeasuresThe primary outcome was intracranial hemorrhage after intravenous alteplase during the index hospitalization (the hospitalization subsequent to alteplase administration). Secondary outcomes were major bleeding events and mortality during the index hospitalization. Propensity score matching was used to control potential confounders. Logistic regression was used to estimate the odds ratio (OR) of outcome events. Meta-analysis was performed using a random-effects model.ResultsOf the 7483 included patients (mean [SD] age, 67.4 [12.7] years; 2908 [38.9%] female individuals and 4575 [61.1%] male individuals), 91 (1.2%), 182 (2.4%), and 7210 (96.4%) received NOACs, warfarin, and no anticoagulants prior to their stroke, respectively. Compared to patients who were not treated with anticoagulants, those treated with NOACs did not have significantly higher risks of intracranial hemorrhage (risk difference [RD], 2.47% [95% CI, −4.23% to 9.17%]; OR, 1.37 [95% CI, 0.62-3.03]), major bleeding (RD, 4.95% [95% CI, −2.56% to 12.45%]; OR, 1.69 [95% CI, 0.83-3.45]), or in-hospital mortality (RD, −4.95% [95% CI, −10.11% to 0.22%]; OR, 0.45 [95% CI, 0.15-1.29]) in the propensity score–matched analyses. Furthermore, the risks of bleeding and mortality were not significantly different between patients treated with NOACs and those treated with warfarin. Similar results were obtained in the meta-analysis.Conclusions and RelevanceIn this cohort study with meta-analysis, compared to no treatment with anticoagulants, treatment with NOACs prior to stroke was not associated with a higher risk of intracranial hemorrhage, major bleeding, or mortality in patients receiving intravenous alteplase for acute ischemic stroke.

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

Cited by 35 publications

References 24 publications

Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18

Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18

Positive Predictive Value of ICD-10 Codes for Cerebral Venous Sinus Thrombosis in Taiwan’s National Health Insurance Claims Database

Risk of Bleeding Following Non–Vitamin K Antagonist Oral Anticoagulant Use in Patients With Acute Ischemic Stroke Treated With Alteplase

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