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J Clin Epidemiol. 2009 Mar;62(3):321-7, 327.e1-7. doi: 10.1016/j.jclinepi.2008.06.006. Epub 2008 Oct 1.

Administrative codes combined with medical records based criteria accurately identified bacterial infections among rheumatoid arthritis patients.

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  • 1Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham, Birmingham, AL 35294-3408, USA.

Abstract

OBJECTIVE:

To evaluate diagnostic properties of International Classification of Diseases, Version 9 (ICD-9) diagnosis codes and infection criteria to identify bacterial infections among rheumatoid arthritis (RA) patients.

STUDY DESIGN AND SETTING:

We performed a cross-sectional study of RA patients with and without ICD-9 codes for bacterial infections. Sixteen bacterial infection criteria were developed. Diagnostic properties of comprehensive and restrictive sets of ICD-9 codes and the infection criteria were tested against an adjudicated review of medical records.

RESULTS:

Records on 162 RA patients with and 50 without purported bacterial infections were reviewed. Positive and negative predictive values of ICD-9 codes ranged from 54%-85% and 84%-100%, respectively. Positive predictive values of the medical records based criteria were 84% and 89% for "definite" and "definite or empirically treated" infections, respectively. Positive predictive value of infection criteria increased by 50% as disease prevalence increased using ICD-9 codes to enhance infection likelihood.

CONCLUSION:

ICD-9 codes alone may misclassify bacterial infections in hospitalized RA patients. Misclassification varies with the specificity of the codes used and strength of evidence required to confirm infections. Combining ICD-9 codes with infection criteria identified infections with greatest accuracy. Novel infection criteria may limit the requirement to review medical records.

Comment in

PMID:
18834713
[PubMed - indexed for MEDLINE]
PMCID:
PMC2736855
Free PMC Article

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