Validating malignant melanoma ICD-9-CM codes in Umbria, ASL Napoli 3 Sud and Friuli Venezia Giulia administrative healthcare databases: a diagnostic accuracy study

• Published in: BMJ open Vol. 8; no. 4; p. e020631
• Main Authors: Orso, Massimiliano, Serraino, Diego, Abraha, Iosief, Fusco, Mario, Giovannini, Gianni, Casucci, Paola, Cozzolino, Francesco, Granata, Annalisa, Gobbato, Michele, Stracci, Fabrizio, Ciullo, Valerio, Vitale, Maria Francesca, Eusebi, Paolo, Orlandi, Walter, Montedori, Alessandro, Bidoli, Ettore
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2018; BMJ Publishing Group
• Subjects: Accuracy; Adult; Chronic obstructive pulmonary disease; Codes; Databases, Factual; Delivery of Health Care - organization & administration; Disease; Epidemiology; Female; Health risk assessment; Hospitals; Humans; International Classification of Diseases; Italy; Male; Medical diagnosis; Medical prognosis; Melanoma; Melanoma - diagnosis; Metastasis; Middle Aged; Oncology; Patients; Public health; Skin cancer; Skin Neoplasms - diagnosis; Systematic review; Vaccines; Italy; Icd-9-cm; accuracy; melanoma; validity; administrative database; sensitivity and specificity
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2017-020631

ObjectivesTo assess the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in identifying subjects with melanoma.DesignA diagnostic accuracy study comparing melanoma ICD-9-CM codes (index test) with medical chart (reference standard). Case ascertainment was based on neoplastic lesion of the skin and a histological diagnosis from a primary or metastatic site positive for melanoma.SettingAdministrative databases from Umbria Region, Azienda Sanitaria Locale (ASL) Napoli 3 Sud (NA) and Friuli Venezia Giulia (FVG) Region.Participants112, 130 and 130 cases (subjects with melanoma) were randomly selected from Umbria, NA and FVG, respectively; 94 non-cases (subjects without melanoma) were randomly selected from each unit.Outcome measuresSensitivity and specificity for ICD-9-CM code 172.x located in primary position.ResultsThe most common melanoma subtype was malignant melanoma of skin of trunk, except scrotum (ICD-9-CM code: 172.5), followed by malignant melanoma of skin of lower limb, including hip (ICD-9-CM code: 172.7). The mean age of the patients ranged from 60 to 61 years. Most of the diagnoses were performed in surgical departments.The sensitivities were 100% (95% CI 96% to 100%) for Umbria, 99% (95% CI 94% to 100%) for NA and 98% (95% CI 93% to 100%) for FVG. The specificities were 88% (95% CI 80% to 93%) for Umbria, 77% (95% CI 69% to 85%) for NA and 79% (95% CI 71% to 86%) for FVG.ConclusionsThe case definition for melanoma based on clinical or instrumental diagnosis, confirmed by histological examination, showed excellent sensitivities and good specificities in the three operative units. Administrative databases from the three operative units can be used for epidemiological and outcome research of melanoma.