Clinical epidemiology · 2026
Validity of Administrative ICD-10 Diagnosis Codes for Ventricular Arrhythmia and Cardiac Arrest in a French University Hospital.
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Pluquet Maxime, Balcaen Thibaut, Laville Solène M, Liabeuf Sophie
Аннотация
PURPOSE: Drug-induced QT interval prolongation increases the risk of ventricular arrhythmias and cardiac arrest. Assessing these outcomes in electronic health databases and evaluating their association with drug exposure requires prior validation of administrative diagnostic codes. This study aimed to evaluate the positive predictive value (PPV) of International Classification of Diseases, 10th revision (ICD-10) codes for ventricular arrhythmias and cardiac arrest in the French hospital discharge summary database (Programme de Médicalisation des Systèmes d'Information (PMSI)).
METHODS: In a retrospective validation study, we examined PMSI data recorded at Amiens University Medical Center (Amiens, France). Hospital stays between September 2022 and August 2025 with ICD-10 codes for cardiac arrest (I46.0, I46.9), ventricular tachycardia (I47.2), or ventricular fibrillation/flutter (I49.0) were identified. Events were confirmed by electronic medical record review. PPVs with 95% confidence intervals (CI) were calculated. The study design prevented the estimation of sensitivity, specificity, and negative predictive values. Sensitivity analyses were stratified by year, and by type of care unit. Exposure to QT-prolonging medications prior to events was also assessed.
RESULTS: In a population of 182 patients (median age: 66 years; 75% males; in-hospital mortality rate: 45%), PPVs [95% CI] for all diagnosis codes were high: 0.98 [0.95; 1.00] for cardiac arrest with successful resuscitation, 0.96 [0.79; 1.00] for unspecified cardiac arrest, 0.99 [0.94; 1.00] for ventricular tachycardia, and 0.93 [0.87; 0.97] for ventricular fibrillation/flutter. Sensitivity analyses yielded consistent results. Overall, 49.7% of patients had been exposed to ≥1 QT-prolonging medications prior to a validated event, and 26.5% to ≥2 of these medications concomitantly.
CONCLUSION: The high PPVs in PMSI data supports the use of the evaluated ICD-10 codes for outcome identification in pharmacoepidemiological studies of electronic health databases in general, and those investigating QT-prolonging medication use and the risk of serious cardiac events in particular.
METHODS: In a retrospective validation study, we examined PMSI data recorded at Amiens University Medical Center (Amiens, France). Hospital stays between September 2022 and August 2025 with ICD-10 codes for cardiac arrest (I46.0, I46.9), ventricular tachycardia (I47.2), or ventricular fibrillation/flutter (I49.0) were identified. Events were confirmed by electronic medical record review. PPVs with 95% confidence intervals (CI) were calculated. The study design prevented the estimation of sensitivity, specificity, and negative predictive values. Sensitivity analyses were stratified by year, and by type of care unit. Exposure to QT-prolonging medications prior to events was also assessed.
RESULTS: In a population of 182 patients (median age: 66 years; 75% males; in-hospital mortality rate: 45%), PPVs [95% CI] for all diagnosis codes were high: 0.98 [0.95; 1.00] for cardiac arrest with successful resuscitation, 0.96 [0.79; 1.00] for unspecified cardiac arrest, 0.99 [0.94; 1.00] for ventricular tachycardia, and 0.93 [0.87; 0.97] for ventricular fibrillation/flutter. Sensitivity analyses yielded consistent results. Overall, 49.7% of patients had been exposed to ≥1 QT-prolonging medications prior to a validated event, and 26.5% to ≥2 of these medications concomitantly.
CONCLUSION: The high PPVs in PMSI data supports the use of the evaluated ICD-10 codes for outcome identification in pharmacoepidemiological studies of electronic health databases in general, and those investigating QT-prolonging medication use and the risk of serious cardiac events in particular.