Cited by 414Medical Coding and Health InformationAcute Ischemic Stroke ManagementArtificial Intelligence in Healthcare

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Validity of diagnostic codes for acute stroke in administrative databases: a systematic review.

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McCormick, Natalie, Bhole, Vidula, Lacaille, Diane, Avina-Zubieta, J. Antonio·2015·PLoS ONE

DOI 10.1371/journal.pone.0135834PMC PMC4546158

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Abstract

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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Fig 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-style Flowchart of Study Selection and Review. ICD = International Classification of Diseases.CC BY · PubMed Central

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Authors: McCormick, N., Bhole, V., Lacaille, D., & Avina-Zubieta, J. A.
Affiliations: University of British Columbia (CA)
ORCID: McCormick, Natalie
Lacaille, Diane
Venue: PLoS ONE
Publisher: Public Library of Science (PLoS)
Published: 2015-08-20
Volume: 10
Issue: 8
Pages: e0135834
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0135834
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: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
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 › Clinical Neurology › 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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Validity of diagnostic codes for acute stroke in administrative databases: a systematic review.

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