Isolated subsegmental pulmonary embolism identification based on international classification of diseases (ICD)-10 codes and imaging reports

Sina Rashedi¹, Antoine Bejjani², Andetta R Hunsaker³, Ayaz Aghayev³, Candrika D Khairani¹, Bridget McGonagle¹, Ying-Chih Lo⁴, Shiwani Mahajan⁵, César Caraballo⁶, Jose Victor Jimenez⁷, Darsiya Krishnathasan¹, Mehrdad Zarghami⁸, Manuel Monreal⁹, Stefano Barco¹⁰, Eric A Secemsky¹¹, Frederikus A Klok¹², Alfonso Muriel¹³, Mohamad A Hussain¹⁴, Abena Appah-Sampong¹⁴, Farbod N Rahaghi¹⁵, Parham Sadeghipour¹⁶, Zhenqiu Lin⁷, Hamid Mojibian¹⁷, Sanjay Aneja¹⁸, Stavros Konstantinides¹⁹, Samuel Z Goldhaber²⁰, Liqin Wang⁴, Li Zhou⁴, David Jimenez²¹, Harlan M Krumholz²², Gregory Piazza²⁰, Behnood Bikdeli²³; PE-EHR+ Investigators

Affiliations

¹ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
² Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³ Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
⁶ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
⁷ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA.
⁸ Jamaica Hospital Medical Center, Queens, NY 11418, USA.
⁹ Cátedra de Enfermedad Tromboembólica, Universidad Católica de Murcia, Murcia, Spain.
¹⁰ Department of Angiology, University Hospital Zurich, Zurich, Switzerland; Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany.
¹¹ Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹² Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Centre, Leiden, the Netherlands.
¹³ Biostatistics Department, Hospital Ramón y Cajal, and Universidad de Alcalá (IRYCIS), Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
¹⁴ Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
¹⁵ Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹⁶ Vascular Diseases and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran.
¹⁷ Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.
¹⁸ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.
¹⁹ Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
²⁰ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
²¹ Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain.
²² YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
²³ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: bbikdeli@bwh.harvard.edu.

PMID: 39862754
DOI: 10.1016/j.thromres.2025.109271

Isolated subsegmental pulmonary embolism identification based on international classification of diseases (ICD)-10 codes and imaging reports

Sina Rashedi et al. Thromb Res. 2025 Mar.

. 2025 Mar:247:109271.

doi: 10.1016/j.thromres.2025.109271. Epub 2025 Jan 20.

Authors

Affiliations

¹ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
² Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³ Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
⁶ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
⁷ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA.
⁸ Jamaica Hospital Medical Center, Queens, NY 11418, USA.
⁹ Cátedra de Enfermedad Tromboembólica, Universidad Católica de Murcia, Murcia, Spain.
¹⁰ Department of Angiology, University Hospital Zurich, Zurich, Switzerland; Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany.
¹¹ Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹² Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Centre, Leiden, the Netherlands.
¹³ Biostatistics Department, Hospital Ramón y Cajal, and Universidad de Alcalá (IRYCIS), Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
¹⁴ Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
¹⁵ Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹⁶ Vascular Diseases and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran.
¹⁷ Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.
¹⁸ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.
¹⁹ Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
²⁰ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
²¹ Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain.
²² YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
²³ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: bbikdeli@bwh.harvard.edu.

PMID: 39862754
DOI: 10.1016/j.thromres.2025.109271

Abstract

Background: Isolated subsegmental pulmonary embolism (issPE) is a commonly encountered diagnosis. Although the International Classification of Diseases (ICD)-10 codes are used for research, their validity for identifying issPE is unknown. Moreover, issPE diagnosis is challenging, and the findings from radiology reports may conflict with those from expert radiologists.

Methods: Based on prespecified criteria, 1734 medical records of adult patients hospitalized within the Mass General Brigham health system (2016-2021) were selected in three equal groups: (1) patients with principal discharge diagnosis codes for PE, (2) patients with secondary discharge diagnosis codes for PE, and (3) patients with no PE codes. The accuracy of ICD-10 codes for issPE was verified by two independent physicians and weighted by total hospitalizations. In a randomly selected sample of 70 patients, the accuracy of initial radiology reports was determined through a blinded re-evaluation by two expert radiologists.

Results: In weighted estimates, ICD-10 codes in primary or secondary discharge positions, compared with chart reviews, showed a low sensitivity (7.0 %) and positive predictive value (25.2 %). Evaluation by two expert radiologists noted that initial radiology reports were sensitive (97.1 %) for issPE but had a low specificity (40.0 %). Two (3.6 %) out of 55 patients with initial issPE reports did not have PE, while 19 (34.5 %) had more proximal PE.

Conclusions: ICD-10 codes for issPE have poor sensitivity and positive predictive value and should not be used for research or quality improvement. Radiology reports for issPE may be inaccurate regarding the location or, less often, the presence of PE.

Keywords: Diagnosis; International classification of diseases; Sensitivity; Specificity; Subsegmental pulmonary embolism.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest Dr. Bejjani would like to acknowledge the training received under the Scholars in HeAlth Research Program (SHARP) that was in part supported by the Fogarty International Center and Office of Dietary Supplements of the National Institutes of Health (Award Number D43 TW009118). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Aghayev reports a consultant/advisory role to Elucid: arterial analysis software and a consultant role in the WCG imaging lab. Dr. Hussain reports research grants from Vascular Therapies (ACCESS-2 Trial), Humacyte, Inc (V-012 Trial; consulting), VenoStent (SAVE-FistulaS Trial); and is funded by a Brigham and Women's Hospital Heart and Vascular Center Faculty Award and Brigham and Women's Osteen Award. Dr. Piazza received research grants from BMS/Pfizer, Janssen, Alexion, Bayer, Amgen, BSC, Esperion, and 1R01HL164717-01. Dr. Konstantinides reports institutional grants and personal lecture/advisory fees from Bayer AG, Daiichi Sankyo, Boston Scientific, and Penumbra Inc., and institutional grants from Inari Medical, all outside the submitted work. Dr. Piazza reports an advisory Role for BSC, Amgen, BCRI, PERC, NAMSA, BMS, Janssen, and Regeneron. Outside the submitted work, Dr. Bikdeli was supported by the Scott Schoen and Nancy Adams IGNITE Award and is supported by the Mary Ann Tynan Research Scientist award from the Mary Horrigan Connors Center for Women's Health and Gender Biology at Brigham and Women's Hospital, and the Heart and Vascular Center Junior Faculty Award from Brigham and Women's Hospital. Dr. Bikdeli reports that he was a consulting expert on behalf of the plaintiff for litigation related to two specific brand models of IVC filters. Dr. Bikdeli has not been involved in the litigation in 2022–2024, nor has he received any compensation in 2022–2024. Dr. Bikdeli reports that he is a member of the Medical Advisory Board for the North American Thrombosis Forum and serves in the Data Safety and Monitory Board of the NAIL-IT trial funded by the National Heart, Lung, and Blood Institute and Translational Sciences. Dr. Bikdeli is a collaborating consultant with the International Consulting Associates and the U.S. Food and Drug Administration in a study to generate knowledge about the utilization, predictors, retrieval, and safety of IVC filters. Dr. Bikdeli receives compensation as an Associated Editor for the New England Journal of Medicine Journal Watch Cardiology, as an Associate Editor for Thrombosis Research, and as an Executive Associate Editor for JACC, and is a Section Editor for Thrombosis and Hemostasis (no compensation). The other authors have no conflicts of interest to disclose.

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- ClinicalKey
- Elsevier Science
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Isolated subsegmental pulmonary embolism identification based on international classification of diseases (ICD)-10 codes and imaging reports

Affiliations

Isolated subsegmental pulmonary embolism identification based on international classification of diseases (ICD)-10 codes and imaging reports

Authors

Affiliations

Abstract

Conflict of interest statement

MeSH terms

LinkOut - more resources

Full Text Sources

Medical