Validity of International Classification of Diseases, Tenth Revision, codes for atrial fibrillation/flutter in critically ill patients with sepsis
Authors' conclusion
ICD-10 codes perform well in identifying clinical AF/AFL in critically ill sepsis. However, their temporal specificity in distinguishing incidents from prevalent AF/AFL is limited.
Study context
- Population
- Adults with sepsis and septic shock admitted to the ICU400 randomly selected for chart review
- Participants
- 6,554 adults
- Comparison
- ICD-10 codes vs manual chart review for atrial fibrillation (AF)/atrial flutter (AFL)
- ICD-10 codesn = 400
- Manual chart reviewn = 400reference
- Outcome
- Validity of ICD-10 codes for identifying AF/AFL (sensitivity, specificity, PPV, NPV) vs manual chart review
Methodological detailsvalidation study, manual chart review reference standard, random sample
- Validation study
- Manual chart review reference standard
- Random sample
Performance
As reported in the abstract
Any AF/AFL
| Test or model | NPV | Specificity | PPV | Sensitivity |
|---|---|---|---|---|
| ICD-10 codes | 97.3% | 99.7% | 99.1% | 93.0% |
ICD-10 codes
NPV97.3%
Specificity99.7%
PPV99.1%
Sensitivity93.0%
- Patients lacking ICD-10 codes for AF/AFL; absence confirmed by chart review
- 293; 286
- Patients with ICD-10 codes for AF/AFL; confirmed by chart review
- 107; 106
Further findings
| Outcome | ICD-10 codes |
|---|---|
| Incident vs prevalent AF/AFL (codes dated during index admission presumed incident) | |
| Incident AF/AFL PPV | 59.1% |
| Incident AF/AFL specificity | 95.1% |
| Prevalent AF/AFL specificity | 99.7% |
| Incident AF/AFL sensitivity | 76.5% |
| Prevalent AF/AFL sensitivity | 77.5% |
- Incident vs prevalent AF/AFL (codes dated during index admission presumed incident) — Confirmed AF/AFL; with ICD-10 codes dated during index admission (all confirmed)
- 114; 44
- Incident vs prevalent AF/AFL (codes dated during index admission presumed incident) — Index-admission coded patients with prior documentation of AF/AFL
- 18
Original publication
Validity of International Classification of Diseases, Tenth Revision, codes for atrial fibrillation/flutter in critically ill patients with sepsis. Anaesth Crit Care Pain Med. Published 29 May 2024. doi:10.
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