title: Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal Failure.
abstract: Administrative and claims databases may be useful for the study of acute renal failure (ARF) and ARF that requires dialysis (ARF-D), but the validity of the corresponding diagnosis and procedure codes is unknown. The performance characteristics of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for ARF were assessed against serum creatinine-based definitions of ARF in 97,705 adult discharges from three Boston hospitals in 2004. For ARF-D, ICD-9-CM codes were compared with review of medical records in 150 patients with ARF-D and 150 control patients. As compared with a diagnostic standard of a 100% change in serum creatinine, ICD-9-CM codes for ARF had a sensitivity of 35.4%, specificity of 97.7%, positive predictive value of 47.9%, and negative predictive value of 96.1%. As compared with review of medical records, ICD-9-CM codes for ARF-D had positive predictive value of 94.0% and negative predictive value of 90.0%. It is concluded that administrative databases may be a powerful tool for the study of ARF, although the low sensitivity of ARF codes is an important caveat. The excellent performance characteristics of ICD-9-CM codes for ARF-D suggest that administrative data sets may be particularly well suited for research endeavors that involve patients with ARF-D.
authors.affiliation: Renal Division and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. swaikar@partners.org
authors.forename: Sushrut S
authors.initials: SS
authors.lastname: Waikar
authors.forename: Ron
authors.initials: R
authors.lastname: Wald
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: Gary C
authors.initials: GC
authors.lastname: Curhan
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.forename: Orfeas
authors.initials: O
authors.lastname: Liangos
authors.forename: Marie-Anne
authors.initials: MA
authors.lastname: Sosa
authors.forename: Bertrand L
authors.initials: BL
authors.lastname: Jaber
mesh_terms: D058186:Acute Kidney Injury / Q000145:classification* / Q000175:diagnosis; D000368:Aged; D003953:Diagnosis-Related Groups; D005260:Female; D005568:Forms and Records Control; D006753:Hospital Records; D006801:Humans; D007344:Insurance Claim Reporting; D038801:International Classification of Diseases; D039703:Logical Observation Identifiers Names and Codes; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015233:Models, Statistical; D012189:Retrospective Studies