Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Administrative codes may have limited utility in diagnosing biliary colic in emergency department visits: A validation study

  • Jordan Nantais (Division of General Surgery, St. Michael's Hospital, Unity Health Toronto) ;
  • Muhammad Mansour (Division of General Surgery, St. Michael's Hospital, Unity Health Toronto) ;
  • Charles de Mestral (Department of Surgery, Faculty of Medicine, University of Toronto) ;
  • Shiva Jayaraman (Division of General Surgery, St. Joseph's Hospital, Unity Health Toronto) ;
  • David Gomez (Division of General Surgery, St. Michael's Hospital, Unity Health Toronto)
  • Received : 2021.12.22
  • Accepted : 2022.03.03
  • Published : 2022.08.31
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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.

Keywords

Acknowledgement

This work was presented at American College of Surgeons Clinical Congress; 2020 Oct 4-8; Chicago, IL, USA (virtual due to COVID-19 pandemic).

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