Validation of ICD-10 codes for studying foreign body airway obstructions: A health administrative data cohort study

Cody L Dunne; Julia Cirone; Andrew D McRae; Ian Blanchard; Jayna Holroyd-Ledu; Khara Sauro

doi:10.1016/j.resplu.2023.100479

Validation of ICD-10 codes for studying foreign body airway obstructions: A health administrative data cohort study

Resusc Plus. 2023 Oct 6:16:100479. doi: 10.1016/j.resplu.2023.100479. eCollection 2023 Dec.

Authors

Cody L Dunne^{1

2}, Julia Cirone¹, Andrew D McRae^{1

2}, Ian Blanchard^{2

3}, Jayna Holroyd-Ledu^{2

4}, Khara Sauro^{2

5

6}

Affiliations

¹ Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada.
² Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
³ Emergency Medical Services, Alberta Health Services, AB, Canada.
⁴ Department of Medicine, University of Calgary, Calgary, AB, Canada.
⁵ Department of Oncology & Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada.
⁶ Department of Surgery, University of Calgary, Calgary, AB, Canada.

Abstract

Aim: To validate a case definition for foreign body airway obstructions (FBAO) using International Classification of Diseases version 10 (ICD-10) codes to accurately identify patients in administrative health databases and improve reporting on this injury.

Methods: We identified prehospital patient encounters in Alberta, Canada between Jan 1, 2018 and Dec 31, 2021 by querying the provincial emergency medical services' (EMS) patient care records for FBAO-related presentations, EMS protocols, or treatments. We deterministically linked EMS patient encounters to data on emergency department visits and hospital admissions, which included ICD-10 codes. Two physicians independently reviewed encounters to determine true FBAO cases. We then calculated diagnostic accuracy measures (sensitivity, specificity, likelihood ratios) of various algorithms.

Results: We identified 3677 EMS patient encounters, 2121 were linked to hospital administrative databases. Of these encounters, 825 (38.9%) were true FBAO. The combination of two ICD-10 codes (T17 = foreign body in the respiratory tract or T18.0 = foreign body in the mouth) was the most specific algorithm (96.9% [95%CI 95.8-97.8%]), while the combination of all FBAO-related ICD-10 codes and R06.8 (other breathing abnormalities) was the most sensitive (75.0% [95%CI 71.9-78.0]). We identified an additional 453 (35.4%) FBAO cases not transported by EMS (due to death or transport refusal), and therefore not linked to the hospital administrative databases. Of these unlinked encounters, 44 (9.7%) cases resulted in the patient's death.

Conclusions: FBAO can be identified with reasonable accuracy using health administrative data and ICD-10 codes. All algorithms had a trade-off between sensitivity and specificity, and failed to identify a third of FBAO cases, of which 10% resulted in death.

Keywords: Choking; Epidemiology; FBAO; Health administrative data; ICD-10; Prehospital.