• Sydney A Jones, Rebecca F Gottesman, Eyal Shahar, Lisa Wruck, and Wayne D Rosamond.
• From the Department of Epidemiology (S.A.J., W.D.R.) and Department of Biostatistics (L.W.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); and Epidemiology and Biostatistics Division, the University of Arizona College of Public Health, Tucson (E.S.).
• Stroke. 2014 Nov 1; 45 (11): 3219-25.

Background And PurposeCharacterizing International Classification of Disease 9th Revision, Clinical Modification (ICD-9-CM) code validity is essential given widespread use of hospital discharge databases in research. Using the Atherosclerosis Risk in Communities (ARIC) Study, we estimated the accuracy of ICD-9-CM stroke codes.MethodsHospitalizations with ICD-9-CM codes 430 to 438 or stroke keywords in the discharge summary were abstracted for ARIC cohort members (1987-2010). A computer algorithm and physician reviewer classified definite and probable ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Using ARIC classification as a gold standard, we calculated the positive predictive value (PPV) and sensitivity of ICD-9-CM codes grouped according to the American Heart Association/American Stroke Association (AHA/ASA) 2013 categories and an alternative code grouping for comparison.ResultsThirty-three percent of 4260 hospitalizations were validated as strokes (1251 ischemic, 120 intracerebral hemorrhage, 46 subarachnoid hemorrhage). The AHA/ASA code groups had PPV 76% and 68% sensitivity compared with PPV 72% and 83% sensitivity for the alternative code groups. The PPV of the AHA/ASA code group for ischemic stroke was slightly higher among blacks, individuals <65 years, and at teaching hospitals. Sensitivity was higher among older individuals and increased over time. The PPV of the AHA/ASA code group for intracerebral hemorrhage was higher among blacks, women, and younger individuals. PPV and sensitivity varied across study sites.ConclusionsA new AHA/ASA discharge code grouping to identify stroke had similar PPV and lower sensitivity compared with an alternative code grouping. Accuracy varied by patient characteristics and study sites.© 2014 American Heart Association, Inc.

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