Isolated subsegmental pulmonary embolism identification based on international classification of diseases (ICD)-10 codes and imaging reports

Sina Rashedi; Antoine Bejjani; Andetta R Hunsaker; Ayaz Aghayev; Candrika D Khairani; Bridget McGonagle; Ying-Chih Lo; Shiwani Mahajan; César Caraballo; Jose Victor Jimenez; Darsiya Krishnathasan; Mehrdad Zarghami; Manuel Monreal; Stefano Barco; Eric A Secemsky; Frederikus A Klok; Alfonso Muriel; Mohamad A Hussain; Abena Appah-Sampong; Farbod N Rahaghi; Parham Sadeghipour; Zhenqiu Lin; Hamid Mojibian; Sanjay Aneja; Stavros Konstantinides; Samuel Z Goldhaber; Liqin Wang; Li Zhou; David Jimenez; Harlan M Krumholz; Gregory Piazza; Behnood Bikdeli; PE-EHR+ Investigators

doi:10.1016/j.thromres.2025.109271

Isolated subsegmental pulmonary embolism identification based on international classification of diseases (ICD)-10 codes and imaging reports

Thromb Res. 2025 Jan 20:247:109271. doi: 10.1016/j.thromres.2025.109271. Online ahead of print.

Authors

Sina Rashedi¹, Antoine Bejjani², Andetta R Hunsaker³, Ayaz Aghayev³, Candrika D Khairani¹, Bridget McGonagle¹, Ying-Chih Lo⁴, Shiwani Mahajan⁵, César Caraballo⁶, Jose Victor Jimenez⁷, Darsiya Krishnathasan¹, Mehrdad Zarghami⁸, Manuel Monreal⁹, Stefano Barco¹⁰, Eric A Secemsky¹¹, Frederikus A Klok¹², Alfonso Muriel¹³, Mohamad A Hussain¹⁴, Abena Appah-Sampong¹⁴, Farbod N Rahaghi¹⁵, Parham Sadeghipour¹⁶, Zhenqiu Lin⁷, Hamid Mojibian¹⁷, Sanjay Aneja¹⁸, Stavros Konstantinides¹⁹, Samuel Z Goldhaber²⁰, Liqin Wang⁴, Li Zhou⁴, David Jimenez²¹, Harlan M Krumholz²², Gregory Piazza²⁰, Behnood Bikdeli²³; PE-EHR+ Investigators

Affiliations

¹ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
² Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³ Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
⁶ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
⁷ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA.
⁸ Jamaica Hospital Medical Center, Queens, NY 11418, USA.
⁹ Cátedra de Enfermedad Tromboembólica, Universidad Católica de Murcia, Murcia, Spain.
¹⁰ Department of Angiology, University Hospital Zurich, Zurich, Switzerland; Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany.
¹¹ Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹² Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Centre, Leiden, the Netherlands.
¹³ Biostatistics Department, Hospital Ramón y Cajal, and Universidad de Alcalá (IRYCIS), Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
¹⁴ Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
¹⁵ Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹⁶ Vascular Diseases and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran.
¹⁷ Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.
¹⁸ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.
¹⁹ Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
²⁰ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
²¹ Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain.
²² YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
²³ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: bbikdeli@bwh.harvard.edu.

PMID: 39862754
DOI: 10.1016/j.thromres.2025.109271

Abstract

Background: Isolated subsegmental pulmonary embolism (issPE) is a commonly encountered diagnosis. Although the International Classification of Diseases (ICD)-10 codes are used for research, their validity for identifying issPE is unknown. Moreover, issPE diagnosis is challenging, and the findings from radiology reports may conflict with those from expert radiologists.

Methods: Based on prespecified criteria, 1734 medical records of adult patients hospitalized within the Mass General Brigham health system (2016-2021) were selected in three equal groups: (1) patients with principal discharge diagnosis codes for PE, (2) patients with secondary discharge diagnosis codes for PE, and (3) patients with no PE codes. The accuracy of ICD-10 codes for issPE was verified by two independent physicians and weighted by total hospitalizations. In a randomly selected sample of 70 patients, the accuracy of initial radiology reports was determined through a blinded re-evaluation by two expert radiologists.

Results: In weighted estimates, ICD-10 codes in primary or secondary discharge positions, compared with chart reviews, showed a low sensitivity (7.0 %) and positive predictive value (25.2 %). Evaluation by two expert radiologists noted that initial radiology reports were sensitive (97.1 %) for issPE but had a low specificity (40.0 %). Two (3.6 %) out of 55 patients with initial issPE reports did not have PE, while 19 (34.5 %) had more proximal PE.

Conclusions: ICD-10 codes for issPE have poor sensitivity and positive predictive value and should not be used for research or quality improvement. Radiology reports for issPE may be inaccurate regarding the location or, less often, the presence of PE.

Keywords: Diagnosis; International classification of diseases; Sensitivity; Specificity; Subsegmental pulmonary embolism.