Ann Hepatobiliary Pancreat Surg.  2022 Aug;26(3):277-280. 10.14701/ahbps.21-171.

Administrative codes may have limited utility in diagnosing biliary colic in emergency department visits: A validation study

Affiliations
  • 1Division of General Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
  • 2Institute of Medical Science, University of Toronto, Toronto, ON, Canada
  • 3Department of Surgery A, Galilee Medical Center, Faculty of Medicine of the Galilee, Bar-Ilan University, Nahariya, Israel
  • 4Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
  • 5Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
  • 6Division of General Surgery, St. Joseph’s Hospital, Unity Health Toronto, Toronto, ON, Canada

Abstract

Backgrounds/Aims
Biliary colic is a common cause of emergency department (ED) visits; however, the natural history of the disease and thus the indications for urgent or scheduled surgery remain unclear. Limitations of previous attempts to elucidate this natural history at a population level are based on the reliance on the identification of biliary colic via administrative codes in isolation. The purpose of our study was to validate the use of International Statistical Classification of Diseases and Related Health Problems codes, 10th Revision, Canadian modification (ICD-10-CA) from ED visits in adequately differentiating patients with biliary colic from those with other biliary diagnoses such as cholecystitis or common bile duct stones.
Methods
We performed a retrospective validation study using administrative data from two large academic hospitals in Toronto. We assessed all the patients presenting to the ED between January 1, 2012 and December 31, 2018, assigned ICD-10-CA codes in keeping with uncomplicated biliary colic. The codes were compared to the individually abstracted charts to assess diagnostic agreement.
Results
Among the 991 patient charts abstracted, 26.5% were misclassified, corresponding to a positive predictive value of 73% (95% confidence interval 73%–74%). The most frequent reasons for inaccurate diagnoses were a lack of gallstones (49.8%) and acute cholecystitis (27.8%).
Conclusions
Our findings suggest that the use of ICD-10 codes as the sole means of identifying biliary colic to the exclusion of other biliary pathologies is prone to moderate inaccuracy. Previous investigations of biliary colic utilizing administrative codes for diagnosis may therefore be prone to unforeseen bias.

Keyword

Biliary colic; Validation; Health services research

Reference

1. Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F, et al. 2016; Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Ann Transl Med. 4:362. DOI: 10.21037/atm.2016.09.10. PMID: 27826565. PMCID: PMC5075866.
2. Everhart JE, Khare M, Hill M, Maurer KR. 1999; Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology. 117:632–639. DOI: 10.1016/S0016-5085(99)70456-7. PMID: 10464139.
3. Sobolev B, Mercer D, Brown P, FitzGerald M, Jalink D, Shaw R. 2003; Risk of emergency admission while awaiting elective cholecystectomy. CMAJ. 169:662–665. PMID: 14517123. PMCID: PMC202282.
4. Williams TP, Dimou FM, Adhikari D, Kimbrough TD, Riall TS. 2015; Hospital readmission after emergency room visit for cholelithiasis. J Surg Res. 197:318–323. DOI: 10.1016/j.jss.2015.04.032. PMID: 25959838. PMCID: PMC4466203.
5. Altieri MS, Yang J, Zhu C, Sbayi S, Spaniolas K, Talamini M, et al. 2018; What happens to biliary colic patients in New York State? 10-year follow-up from emergency department visits. Surg Endosc. 32:2058–2066. DOI: 10.1007/s00464-017-5902-5. PMID: 29063306.
6. de Mestral C, Rotstein OD, Laupacis A, Hoch JS, Zagorski B, Nathens AB. 2013; A population-based analysis of the clinical course of 10,304 patients with acute cholecystitis, discharged without cholecystectomy. J Trauma Acute Care Surg. 74:26–30. discussion 30–31. DOI: 10.1097/TA.0b013e3182788e4d. PMID: 23271073.
7. Wiggins T, Markar SR, MacKenzie H, Faiz O, Mukherjee D, Khoo DE, et al. 2019; Optimum timing of emergency cholecystectomy for acute cholecystitis in England: population-based cohort study. Surg Endosc. 33:2495–2502. DOI: 10.1007/s00464-018-6537-x. PMID: 30949811. PMCID: PMC6647372.
8. Banz V, Gsponer T, Candinas D, Güller U. 2011; Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy. Ann Surg. 254:964–970. DOI: 10.1097/SLA.0b013e318228d31c. PMID: 21817893.
9. de Mestral C, Rotstein OD, Laupacis A, Hoch JS, Zagorski B, Alali AS, et al. 2014; Comparative operative outcomes of early and delayed cholecystectomy for acute cholecystitis: a population-based propensity score analysis. Ann Surg. 259:10–15. DOI: 10.1097/SLA.0b013e3182a5cf36. PMID: 23979286.
10. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. 2018; Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 25:41–54. DOI: 10.1002/jhbp.515. PMID: 29032636.
11. Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, et al. 2018; Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 25:17–30. DOI: 10.1002/jhbp.512. PMID: 29032610.
12. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. 2013; Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 62:102–111. DOI: 10.1136/gutjnl-2012-302779. PMID: 23100216.
13. Altman DG, Bland JM. 1994; Diagnostic tests 2: predictive values. BMJ. 309:102. DOI: 10.1136/bmj.309.6947.102. PMID: 8038641. PMCID: PMC2540558.
14. van Walraven C, Bennett C, Forster AJ. 2011; Administrative database research infrequently used validated diagnostic or procedural codes. J Clin Epidemiol. 64:1054–1059. DOI: 10.1016/j.jclinepi.2011.01.001. PMID: 21474278.
15. Juurlink D, Preyra C, Croxford R, Chong A, Austin P, Tu J, et al. 2006. Canadian institute for health information discharge abstract database: a validation study [Internet]. Institute for Clinical Evaluative Sciences;Toronto: Available from: https://www.ices.on.ca/flip-publication/canadian-istitute-for-health-information-discharge/files/assets/basic-html/index.html#1. cited 2020 Jul 31.
Full Text Links
  • AHBPS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr