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. 2022 Feb;69(2):e29383.
doi: 10.1002/pbc.29383. Epub 2021 Nov 13.

Positive predictive value and sensitivity of ICD-9-CM codes for identifying pediatric leukemia

Sheila Weinmann  1   2 , Melanie C Francisco  1 , Marilyn L Kwan  3 , Erin J A Bowles  4 , Alanna Kulchak Rahm  5 , Robert T Greenlee  6 , Natasha K Stout  7 , Jason D Pole  8   9   10 , Lawrence H Kushi  3 , Rebecca Smith-Bindman  11   12 , Diana L Miglioretti  13
Affiliations

Positive predictive value and sensitivity of ICD-9-CM codes for identifying pediatric leukemia

Sheila Weinmann et al. Pediatr Blood Cancer. 2022 Feb.

Abstract

Background: To facilitate community-based epidemiologic studies of pediatric leukemia, we validated use of ICD-9-CM diagnosis codes to identify pediatric leukemia cases in electronic medical records of six U.S. integrated health plans from 1996-2015 and evaluated the additional contributions of procedure codes for diagnosis/treatment.

Procedures: Subjects (N = 408) were children and adolescents born in the health systems and enrolled for at least 120 days after the date of the first leukemia ICD-9-CM code or tumor registry diagnosis. The gold standard was the health system tumor registry and/or medical record review. We calculated positive predictive value (PPV) and sensitivity by number of ICD-9-CM codes received in the 120-day period following and including the first code. We evaluated whether adding chemotherapy and/or bone marrow biopsy/aspiration procedure codes improved PPV and/or sensitivity.

Results: Requiring receipt of one or more codes resulted in 99% sensitivity (95% confidence interval [CI]: 98-100%) but poor PPV (70%; 95% CI: 66-75%). Receipt of two or more codes improved PPV to 90% (95% CI: 86-93%) with 96% sensitivity (95% CI: 93-98%). Requiring at least four codes maximized PPV (95%; 95% CI: 92-98%) without sacrificing sensitivity (93%; 95% CI: 89-95%). Across health plans, PPV for four codes ranged from 84-100% and sensitivity ranged from 83-95%. Including at least one code for a bone marrow procedure or chemotherapy treatment had minimal impact on PPV or sensitivity.

Conclusions: The use of diagnosis codes from the electronic health record has high PPV and sensitivity for identifying leukemia in children and adolescents if more than one code is required.

Keywords: adolescents; children; diagnosis codes; leukemia; positive predictive value; sensitivity.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

The authors report no conflict of interest.

Figures

Figure 1.
Figure 1.
Consort diagram
Figure 2.
Figure 2.
Sensitivity versus PPV by number of specific leukemia ICD-9 diagnosis codes (A) and number of specific leukemia ICD-9 diagnosis codes in combination with at least one chemotherapy and/or bone marrow procedure code (Px) (B) within the 120-day observation period. Data point labels indicate number of ICD-9 diagnosis codes. Horizontal and vertical bars at each data point indicate 95% confidence intervals for PPV and sensitivity, respectively.
Figure 2.
Figure 2.
Sensitivity versus PPV by number of specific leukemia ICD-9 diagnosis codes (A) and number of specific leukemia ICD-9 diagnosis codes in combination with at least one chemotherapy and/or bone marrow procedure code (Px) (B) within the 120-day observation period. Data point labels indicate number of ICD-9 diagnosis codes. Horizontal and vertical bars at each data point indicate 95% confidence intervals for PPV and sensitivity, respectively.
See this image and copyright information in PMC

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