Research
Reliability of diagnostic coding in intensive care patients
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* Corresponding author: Benoît Misset bmisset@hpsj.fr
1 Intensive Care Unit, Fondation Hôpital Saint-Joseph, Université Paris-Descartes, Faculté de Médecine, 185 rue Losserand, 75014 Paris, France
2 Conservatoire National des Arts et Métiers, 292 rue Saint Martin, 75003 Paris, France
3 INSERM U823, Epidemiology of Cancer and Severe Illnesses, Albert Bonniot Institute, BP 217, 38043 Grenoble cedex 09, France
4 Intensive Care Unit, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, 1 avenue Vellefaux, 75010 Paris, France
5 Intensive Care Unit, Fondation Hôpital Saint-Joseph, 185 rue Losserand, 75014 Paris, France
6 Intensive Care Unit, Hôpital Bichat – Claude Bernard, Assistance Publique Hôpitaux de Paris, 48 rue Huchard, 75018 Paris, France
7 Intensive Care Unit, Hôpital Delafontaine, Inserm EA 2511, Insitut Cochin, Paris, 2 rue Delafontaine, 93200 Saint Denis,, France
8 Intensive Care Unit, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, 100 boulevard du Général Leclerc, 92118 Clichy cedex, France
9 Intensive Care Unit, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, 4 rue de la Chine, 75020 Paris, France
10 Intensive Care Unit, Centre Hospitalier Général, 25 rue Pierre de Theilley BP 30071, 95503 Gonesse, France
11 Intensive Care Unit, Hôpital Albert Michallon, Université Joseph Fourier, Faculté de Médecine, Grenoble, France
Critical Care 2008, 12:R95 doi:10.1186/cc6969
Published: 29 July 2008Abstract
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.