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Open Access 01-08-2008 | Research

Reliability of diagnostic coding in intensive care patients

Authors: Benoît Misset, Didier Nakache, Aurélien Vesin, Mickael Darmon, Maïté Garrouste-Orgeas, Bruno Mourvillier, Christophe Adrie, Sébastian Pease, Marie-Aliette Costa de Beauregard, Dany Goldgran-Toledano, Elisabeth Métais, Jean-François Timsit, The Outcomerea Database Investigators

Published in: Critical Care | Issue 4/2008

Abstract

Introduction

Administrative coding of medical diagnoses in intensive care unit (ICU) patients is mandatory in order to create databases for use in epidemiological and economic studies. We assessed the reliability of coding between different ICU physicians.

Method

One hundred medical records selected randomly from 29,393 cases collected between 1998 and 2004 in the French multicenter Outcomerea ICU database were studied. Each record was sent to two senior physicians from independent ICUs who recoded the diagnoses using the International Statistical Classification of Diseases and Related Health Problems: Tenth Revision (ICD-10) after being trained according to guidelines developed by two French national intensive care medicine societies: the French Society of Intensive Care Medicine (SRLF) and the French Society of Anesthesiology and Intensive Care Medicine (SFAR). These codes were then compared with the original codes, which had been selected by the physician treating the patient. A specific comparison was done for the diagnoses of septicemia and shock (codes derived from A41 and R57, respectively).

Results

The ICU physicians coded an average of 4.6 ± 3.0 (range 1 to 32) diagnoses per patient, with little agreement between the three coders. The primary diagnosis was matched by both external coders in 34% (95% confidence interval (CI) 25% to 43%) of cases, by only one in 35% (95% CI 26% to 44%) of cases, and by neither in 31% (95% CI 22% to 40%) of cases. Only 18% (95% CI 16% to 20%) of all codes were selected by all three coders. Similar results were obtained for the diagnoses of septicemia and/or shock.

Conclusion

In a multicenter database designed primarily for epidemiological and cohort studies in ICU patients, the coding of medical diagnoses varied between different observers. This could limit the interpretation and validity of research and epidemiological programs using diagnoses as inclusion criteria.

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Title: Reliability of diagnostic coding in intensive care patients
Authors: Benoît Misset
Didier Nakache
Aurélien Vesin
Mickael Darmon
Maïté Garrouste-Orgeas
Bruno Mourvillier
Christophe Adrie
Sébastian Pease
Marie-Aliette Costa de Beauregard
Dany Goldgran-Toledano
Elisabeth Métais
Jean-François Timsit
The Outcomerea Database Investigators
Publication date: 01-08-2008
Publisher: BioMed Central
Published in: Critical Care / Issue 4/2008
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc6969

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reliability of diagnostic coding in intensive care patients

Abstract

Introduction

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Method

Results

Conclusion

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