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Sensitivity and Specificity of Administrative Medical Coding for Pediatric Eosinophilic Esophagitis

Robson, Jacob*; Korgenski, Kent; Parsons, Karyn; McClain, Amber*; Barbagelata, Carlos*; Allen-Brady, Kristina§; Patel, Raza*; O’Gorman, Molly*; Peterson, Kathryn||; Guthery, Stephen*

Journal of Pediatric Gastroenterology and Nutrition: August 2019 - Volume 69 - Issue 2 - p e49–e53
doi: 10.1097/MPG.0000000000002340
Original Article: Gastroenterology: Eosinophilic GI Disease
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Objectives: Eosinophilic esophagitis (EoE) is a delayed-type hypersensitivity with increasing rates among pediatric populations. Although studies have used International Classification of Diseases (ICD) coding to define local cohorts and report disease epidemiology, the accuracy of the EoE ICD code for pediatric EoE is unknown.

Methods: We searched the Intermountain Healthcare Database for pediatric cases with the EoE ICD code over a 5-year period. We cross-referenced these results with a recently published pediatric EoE cohort from the same region and period, where incident cases were identified via retrospective review of pathology reports and medical records. Using the retrospective review cohort as the reference standard, we evaluated the accuracy of the EoE ICD code.

Results: Via retrospective review, we identified 1129 new pediatric EoE cases in the Intermountain Healthcare system over 5 years. Six hundred ten of these had the EoE ICD code associated with their chart. Out of 878,872 unique pediatric records in the Intermountain Healthcare system, 219 had the EoE ICD code incorrectly applied. The specificity of the EoE ICD code in children was 99%, but sensitivity and positive predictive value were 61% and 79%, respectively.

Conclusions: The EoE ICD code has strengths and weaknesses in pediatrics. The EoE ICD code is specific, with few false positives across a large population, but not sensitive. The low sensitivity is likely multifactorial and requires further evaluation. Compared to retrospective chart review, which allows for application of clinicopathologic EoE diagnostic criteria, sole use of ICD codes results in underascertainment of EoE cases and key misclassifications.

*Division of Pediatric Gastroenterology, Department of Pediatrics, University of Utah

Pediatric Clinical Program, Intermountain Healthcare

Department of Pediatrics

§Genetic Epidemiology

||Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, UT.

Address correspondence and reprint requests to Jacob Robson, MD, MS, Division of Pediatric Gastroenterology, Department of Pediatrics, University of Utah 81 North Mario Capecchi Drive, Salt Lake City, UT 84113 (e-mail: Jacob.Robson@hsc.utah.edu).

Received 22 September, 2018

Accepted 4 March, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

No funding for this work was received from National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); or other(s).

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,