Assessing the accuracy of ICD-10 coding for measuring rates and mortality from Acute Kidney Injury and the impact of electronic alerts: An observational cohort study

Rachael Logan, Peter Davey, Nicosha De Souza, David Baird, Bruce Guthrie, Samira Bell (Lead / Corresponding author)

Research output: Contribution to journalArticle

Abstract

Background: The application of a uniform definition for Acute Kidney Injury (AKI) is vital in order to advance understanding and management of AKI. ICD-10 coding is frequently used to define AKI but its accuracy in unclear. The aim of this study was to determine whether ICD-10 coding is a reliable method of monitoring rates and outcomes of AKI in inpatients compared to biochemically-defined AKI and whether electronic alerts for AKI affects ICD-10 AKI coding.
Methods: An observational cohort study of all 505,662 adult admissions to acute hospitals in two Scottish Health Boards (NHS Tayside and NHS Fife) January 2013 – April 2017 was performed. AKI e-alerts were implemented in NHS Tayside in April 2015. Sensitivity, specificity, positive and negative predictive values of ICD-10 coding for AKI compared to biochemically-defined AKI using the Kidney Disease Improving Global Outcomes definition and relative risk of 30-day mortality in people with ICD-10 and biochemically-defined AKI before and after AKI e-alert implementation was performed.
Results: Sensitivity of ICD-10 coding for identifying biochemically-defined AKI was very poor in both health boards for both all AKI (Tayside 25.7%, Fife 35.8%) and for stage 2 and 3 AKI (Tayside 43.8%, Fife 53.8%). Positive predictive value was poor for both all AKI (Tayside 76.1%, Fife 45.5%) and for stage 2 and 3 AKI (Tayside 45.5%, Fife 36.8%). Measured mortality fell following implementation of AKI e-alerts in the ICD-10 coded population but not in the biochemically-defined AKI population, reflecting an increase in the proportion of stage 1 AKI in ICD-10 coded AKI. There was no evidence that the introduction of AKI e-alerts in Tayside improved ICD-10 coding of AKI.
Conclusion: ICD-10 coding should not be used for monitoring of rates and outcomes of AKI for either research or improvement.
Original languageEnglish
Article numbersfz117
Number of pages8
JournalClinical Kidney Journal
DOIs
Publication statusPublished - 2019

Keywords

  • Acute kidney injury
  • ICD-10 coding
  • electronic alerts
  • epidemiology

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