Validity of diagnostic codes for acute stroke in administrative databases: a systematic review.
Open accessAbstract
OBJECTIVE: To conduct a systematic review of studies reporting on the validity of International Classification of Diseases (ICD) codes for identifying stroke in administrative data. METHODS: MEDLINE and EMBASE were searched (inception to February 2015) for studies: (a) Using administrative data to identify stroke; or (b) Evaluating the validity of stroke codes in administrative data; and (c) Reporting validation statistics (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), or Kappa scores) for stroke, or data sufficient for their calculation. Additional articles were located by hand search (up to February 2015) of original papers. Studies solely evaluating codes for transient ischaemic attack were excluded. Data were extracted by two independent reviewers; article quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS: Seventy-seven studies published from 1976-2015 were included. The sensitivity of ICD-9 430-438/ICD-10 I60-I69 for any cerebrovascular disease was ≥ 82% in most [≥ 50%] studies, and specificity and NPV were both ≥ 95%. The PPV of these codes for any cerebrovascular disease was ≥ 81% in most studies, while the PPV specifically for acute stroke was ≤ 68%. In at least 50% of studies, PPVs were ≥ 93% for subarachnoid haemorrhage (ICD-9 430/ICD-10 I60), 89% for intracerebral haemorrhage (ICD-9 431/ICD-10 I61), and 82% for ischaemic stroke (ICD-9 434/ICD-10 I63 or ICD-9 434&436). For in-hospital deaths, sensitivity was 55%. For cerebrovascular disease or acute stroke as a cause-of-death on death certificates, sensitivity was ≤ 71% in most studies while PPV was ≥ 87%. CONCLUSIONS: While most cases of prevalent cerebrovascular disease can be detected using 430-438/I60-I69 collectively, acute stroke must be defined using more specific codes. Most in-hospital deaths and death certificates with stroke as a cause-of-death correspond to true stroke deaths. Linking vital statistics and hospitalization data may improve the ascertainment of fatal stroke.
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Differences in coding practices might exist; however, coding for common conditions, especially the life-threatening conditions described in this report, is likely consistent.
“Second, conditions were defined using ICD-10 diagnosis codes. Differences in coding practices might exist; however, coding for common conditions, especially the life-threatening conditions described in this report, is likely consistent (9,10).”
From Potential Indirect Effects of the COVID-19 Pandemic on Use of Emergency Departments for Acute Life-Threatening Conditions — United States, January–May 2020 (2020) · cites this paper as [10]
The Results (Validity by Subgroups; page unavailable) report few differences in stroke-code accuracy between ICD-9 and ICD-10, and similar accuracy for fatal and non-fatal stroke diagnoses. But the Discussion (Regional and Temporal Trends; page unavailable) describes differences between hospital settings, and the review does not establish that coding is generally consistent for the other common, life-threatening conditions in the citing report. (LLM, conf=0.84)
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- Authors
- McCormick, N., Bhole, V., Lacaille, D., & Avina-Zubieta, J. A.
- Affiliations
- University of British Columbia (CA)
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-08-20
- Volume
- 10
- Issue
- 8
- Pages
- e0135834
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4546158
- OpenAlex
- W1751906644
- Cited by
- 414
- References
- 122
- Citations by year
- 2026: 38 · 2025: 43 · 2024: 40 · 2023: 32 · 2022: 44 · 2021: 51 · 2020: 61 · 2019: 37 · 2018: 28 · 2017: 24 · 2016: 16
- FWCI
- 2.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Arthritis Society
- Michael Smith Health Research BC
- Canadian Institutes of Health Research
- Canadian Arthritis Network
- Topics
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
- Keywords
- acute stroke, administrative health data, cerebrovascular disease, subarachnoid hemorrhage, intracerebral hemorrhage, ischemic stroke, in-hospital mortality, cause of death certification, vital statistics
- MeSH terms
- Cerebral Hemorrhage, Ischemic Attack, Transient, Cerebrovascular Disorders, Death Certificates, Hospitalization, Humans, Subarachnoid Hemorrhage, Databases, Factual, Stroke, International Classification of Diseases, Clinical Coding
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