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. 2023 Dec;32(12):1439-1445.
doi: 10.1002/pds.5675. Epub 2023 Aug 1.

Validation of ICD-10 hospital discharge diagnosis codes to identify incident and recurrent ischemic stroke from a US integrated healthcare system

Abraelle M Shirley  1 , Kerresa L Morrisette  1 , Soon Kyu Choi  1 , Kristi Reynolds  1   2 , Hui Zhou  1   2 , Mengnan M Zhou  1 , Rong Wei  1 , Yiyi Zhang  3 , Pamela Cheng  4 , Eric Wong  4 , Navdeep Sangha  4   5 , Jaejin An  1   2
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Validation of ICD-10 hospital discharge diagnosis codes to identify incident and recurrent ischemic stroke from a US integrated healthcare system

Abraelle M Shirley et al. Pharmacoepidemiol Drug Saf. 2023 Dec.

Abstract

Purpose: This study validated incident and recurrent ischemic stroke identified by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) hospital discharge diagnosis codes.

Methods: Using electronic health records (EHR) of adults (≥18 years) receiving care from Kaiser Permanente Southern California with ICD-10 hospital discharge diagnosis codes of ischemic stroke (I63.x, G46.3, and G46.4) between October 2015 and September 2020, we identified 75 patients with both incident and recurrent stroke events (total 150 cases). Two neurologists independently evaluated validity of ICD-10 codes through chart reviews.

Results: The positive predictive value (PPV, 95% CI) for incident stroke was 93% (95% CI: 88%, 99%) and the PPV for recurrent stroke was 72% (95% CI: 62%, 82%). The PPV for recurrent stroke improved after applying a gap of 20 days (PPV of 75%; 95% CI: 63%, 87%) or removing hospital admissions related to stroke-related procedures (PPV of 78%; 95% CI: 68%, 88%).

Conclusion: The ICD-10 hospital discharge diagnosis codes for ischemic stroke showed a high PPV for incident cases, while the PPV for recurrent cases were less optimal. Algorithms to improve the accuracy of ICD-10 codes for recurrent ischemic stroke may be necessary.

Keywords: ICD-10 diagnosis codes; positive predictive value; recurrent stroke.

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Conflict of interest statement

Conflict of interest

Dr. An reports contracts from AstraZeneca and Bayer AG outside the scope of this study.

Dr. Reynolds reports research funding received through her institution from Novartis and CSL Behring, LLC outside the scope of this study.

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