BackgroundThe 10th revision of the International Classification of Diseases, Clinical Modification (ICD‐10) includes diagnosis codes for placenta accreta spectrum for the first time. These codes could enable valuable research and surveillance of placenta accreta spectrum, a life‐threatening pregnancy complication that is increasing in incidence.ObjectiveWe sought to evaluate the validity of placenta accreta spectrum diagnosis codes that were introduced in ICD‐10 and assess contributing factors to incorrect code assignments.MethodsWe calculated sensitivity, specificity, positive predictive value and negative predictive value of the ICD‐10 placenta accreta spectrum code assignments after reviewing medical records from October 2015 to March 2020 at a quaternary obstetric centre. Histopathologic diagnosis was considered the gold standard.ResultsAmong 22,345 patients, 104 (0.46%) had an ICD‐10 code for placenta accreta spectrum and 51 (0.23%) had a histopathologic diagnosis. ICD‐10 codes had a sensitivity of 0.71 (95% CI 0.56, 0.83), specificity of 0.98 (95% CI 0.93, 1.00), positive predictive value of 0.61 (95% CI 0.48, 0.72) and negative predictive value of 1.00 (95% CI 0.96, 1.00). The sensitivities of the ICD‐10 codes for placenta accreta spectrum subtypes— accreta, increta and percreta—were 0.55 (95% CI 0.31, 0.78), 0.33 (95% CI 0.12, 0.62) and 0.56 (95% CI 0.31, 0.78), respectively. Cases with incorrect code assignment were less morbid than cases with correct code assignment, with a lower incidence of hysterectomy at delivery (17% vs 100%), blood transfusion (26% vs 75%) and admission to the intensive care unit (0% vs 53%). Primary reasons for code misassignment included code assigned to cases of occult placenta accreta (35%) or to cases with clinical evidence of placental adherence without histopatholic diagnostic (35%) features.ConclusionThese findings from a quaternary obstetric centre suggest that ICD‐10 codes may be useful for research and surveillance of placenta accreta spectrum, but researchers should be aware of likely substantial false positive cases.

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ICD-10 侵入性胎盘谱系疾病诊断代码的有效性

背景国际疾病分类临床修订版（ICD-10）第十次修订版首次纳入植入性胎盘谱系的诊断代码。这些代码可以对植入性胎盘谱系进行有价值的研究和监测，这是一种发病率不断增加的危及生命的妊娠并发症。 目的我们试图评估 ICD-10 中引入的植入性胎盘谱系诊断代码的有效性，并评估导致不正确的胎盘谱系诊断代码的有效性。方法我们在查看四级产科中心 2015 年 10 月至 2020 年 3 月的病历后，计算了 ICD-10 植入性胎盘谱代码分配的敏感性、特异性、阳性预测值和阴性预测值。组织病理学诊断被认为是金标准。 结果在 22,345 名患者中，104 名 (0.46%) 具有植入性胎盘谱系的 ICD-10 代码，51 名 (0.23%) 具有组织病理学诊断。 ICD-10 代码的敏感性为 0.71（95% CI 0.56，0.83），特异性为 0.98（95% CI 0.93，1.00），阳性预测值为 0.61（95% CI 0.48，0.72），阴性预测值为 1.00（ 95% CI 0.96, 1.00)。 ICD-10 代码对侵入性胎盘谱亚型（侵入性胎盘、侵入性胎盘和穿透性胎盘）的敏感性分别为 0.55 (95% CI 0.31, 0.78)、0.33 (95% CI 0.12, 0.62) 和 0.56 (95% CI 0.31, 0.78) ， 分别。代码分配不正确的病例比代码分配正确的病例发病率更低，分娩时子宫切除术（17% vs 100%）、输血（26% vs 75%）和入住重症监护室（0%）的发生率较低对比 53%）。代码错误分配的主要原因包括分配给隐匿性植入性胎盘病例的代码 (35%) 或分配给具有胎盘粘附临床证据而无组织病理学诊断特征的病例 (35%)。 结论 来自四级产科中心的这些发现表明 ICD-10 代码可能对于植入性胎盘谱系的研究和监测很有用，但研究人员应该意识到可能存在大量假阳性病例。