Diagnostic accuracy of the international classification of disease “I26” code to detect acute pulmonary embolism in a surveillance network
Background: Emergency departments (EDs) offer a unique platform for a surveillance network for acute pulmonary embolism (PE) using International Classification of Disease (ICD-10) codes extracted from electronic medical records. Objectives: Test the diagnostic accuracy of the I26 ''leader&...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-05-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2475037925002249 |
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| author | Jeffrey A. Kline Jesse O. Wrenn Mazin F. Alam Alexis N. Drinkhorn Conner D. Slotnick Fawas Shaman Christopher E. Conn Steven J. Korzeniewski Christopher Kabrhel |
| author_facet | Jeffrey A. Kline Jesse O. Wrenn Mazin F. Alam Alexis N. Drinkhorn Conner D. Slotnick Fawas Shaman Christopher E. Conn Steven J. Korzeniewski Christopher Kabrhel |
| author_sort | Jeffrey A. Kline |
| collection | DOAJ |
| description | Background: Emergency departments (EDs) offer a unique platform for a surveillance network for acute pulmonary embolism (PE) using International Classification of Disease (ICD-10) codes extracted from electronic medical records. Objectives: Test the diagnostic accuracy of the I26 ''leader'' ICD-10 code for the detection of PE in near real-time in a large, ED-based surveillance network. Methods: Standardized structured language queries were deployed at 91 hospitals to extract data, including ICD-10 codes, on a weekly basis from electronic medical records on ED patients with acute respiratory complaints. We used 2 methods for coding computed tomography pulmonary angiogram (CTPA) reports to derive a criterion or gold standard for PE diagnosis: (1) research associates were trained to interpret the CTPA reports, and (2) a validated Regular Expression computer program was used to interpret PE on CTPA reports. These 2 methods were independently adjudicated (PE+ or PE−). The primary outcome was diagnostic accuracy of the I26 leader compared with the final adjudication. Results: From 6448 valid CTPA scan reports, 442 (6.8%) were adjudicated as PE+. On a weekly basis, the I26 leader had a sensitivity of 50.9% (95% CI, 46.1%-55.6%) and a specificity of 99.7% (95% CI, 99.5%-99.8%), likelihood ratio (LR) negative of 0.49 (95% CI, 0.44-0.54) and LR positive of 191 (95% CI, 116-12). At 1 month, the I26 sensitivity was 57.5% (95% CI, 52.7%-62.1%), and specificity was 99.5% (95% CI, 99.2%-99.6%); LRnegative of 0.43 (95% CI, 0.38-0.47) and LRpositive of 111 (95% CI, 77-159). Conclusion: For low-latency surveillance of PE diagnosed in EDs, the ICD leader code I26 affords high specificity and high LR(+) for detection of acute PE in the United States but has modest sensitivity. |
| format | Article |
| id | doaj-art-6592db8b8523445ab6df568347bc68f5 |
| institution | Kabale University |
| issn | 2475-0379 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj-art-6592db8b8523445ab6df568347bc68f52025-08-20T03:38:19ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792025-05-019410290010.1016/j.rpth.2025.102900Diagnostic accuracy of the international classification of disease “I26” code to detect acute pulmonary embolism in a surveillance networkJeffrey A. Kline0Jesse O. Wrenn1Mazin F. Alam2Alexis N. Drinkhorn3Conner D. Slotnick4Fawas Shaman5Christopher E. Conn6Steven J. Korzeniewski7Christopher Kabrhel8Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA; Correspondence Jeffrey Kline, Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine Dr, Detroit, MI 48201.Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USADepartment of Emergency Medicine, Wayne State University, Detroit, Michigan, USADepartment of Emergency Medicine, Wayne State University, Detroit, Michigan, USADepartment of Emergency Medicine, Wayne State University, Detroit, Michigan, USADepartment of Emergency Medicine, Wayne State University, Detroit, Michigan, USADepartment of Emergency Medicine, Wayne State University, Detroit, Michigan, USADepartment of Family Medicine and Public Health Sciences, Detroit, Michigan, USADepartment of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USABackground: Emergency departments (EDs) offer a unique platform for a surveillance network for acute pulmonary embolism (PE) using International Classification of Disease (ICD-10) codes extracted from electronic medical records. Objectives: Test the diagnostic accuracy of the I26 ''leader'' ICD-10 code for the detection of PE in near real-time in a large, ED-based surveillance network. Methods: Standardized structured language queries were deployed at 91 hospitals to extract data, including ICD-10 codes, on a weekly basis from electronic medical records on ED patients with acute respiratory complaints. We used 2 methods for coding computed tomography pulmonary angiogram (CTPA) reports to derive a criterion or gold standard for PE diagnosis: (1) research associates were trained to interpret the CTPA reports, and (2) a validated Regular Expression computer program was used to interpret PE on CTPA reports. These 2 methods were independently adjudicated (PE+ or PE−). The primary outcome was diagnostic accuracy of the I26 leader compared with the final adjudication. Results: From 6448 valid CTPA scan reports, 442 (6.8%) were adjudicated as PE+. On a weekly basis, the I26 leader had a sensitivity of 50.9% (95% CI, 46.1%-55.6%) and a specificity of 99.7% (95% CI, 99.5%-99.8%), likelihood ratio (LR) negative of 0.49 (95% CI, 0.44-0.54) and LR positive of 191 (95% CI, 116-12). At 1 month, the I26 sensitivity was 57.5% (95% CI, 52.7%-62.1%), and specificity was 99.5% (95% CI, 99.2%-99.6%); LRnegative of 0.43 (95% CI, 0.38-0.47) and LRpositive of 111 (95% CI, 77-159). Conclusion: For low-latency surveillance of PE diagnosed in EDs, the ICD leader code I26 affords high specificity and high LR(+) for detection of acute PE in the United States but has modest sensitivity.http://www.sciencedirect.com/science/article/pii/S2475037925002249diagnosisemergency medicineelectronic health recordsepidemiologypulmonary embolismsurveillance |
| spellingShingle | Jeffrey A. Kline Jesse O. Wrenn Mazin F. Alam Alexis N. Drinkhorn Conner D. Slotnick Fawas Shaman Christopher E. Conn Steven J. Korzeniewski Christopher Kabrhel Diagnostic accuracy of the international classification of disease “I26” code to detect acute pulmonary embolism in a surveillance network Research and Practice in Thrombosis and Haemostasis diagnosis emergency medicine electronic health records epidemiology pulmonary embolism surveillance |
| title | Diagnostic accuracy of the international classification of disease “I26” code to detect acute pulmonary embolism in a surveillance network |
| title_full | Diagnostic accuracy of the international classification of disease “I26” code to detect acute pulmonary embolism in a surveillance network |
| title_fullStr | Diagnostic accuracy of the international classification of disease “I26” code to detect acute pulmonary embolism in a surveillance network |
| title_full_unstemmed | Diagnostic accuracy of the international classification of disease “I26” code to detect acute pulmonary embolism in a surveillance network |
| title_short | Diagnostic accuracy of the international classification of disease “I26” code to detect acute pulmonary embolism in a surveillance network |
| title_sort | diagnostic accuracy of the international classification of disease i26 code to detect acute pulmonary embolism in a surveillance network |
| topic | diagnosis emergency medicine electronic health records epidemiology pulmonary embolism surveillance |
| url | http://www.sciencedirect.com/science/article/pii/S2475037925002249 |
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