Published Online
on July 14, 2005

A more recent version of this article appeared on August 1, 2005

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Submitted on March 12, 2005
Revised on April 10, 2005
Accepted on May 3, 2005

Coding of Stroke and Stroke Risk Factors Using International Classification of Diseases, Revisions 9 and 10

Rae A. Kokotailo BSc and Michael D. Hill MD, MSc, FRCPC^*

From the Calgary Stroke Program, Departments of Clinical Neurosciences (M.D.H., R.A.K.), Medicine (M.D.H.), and Community Health Sciences (M.D.H.), Faculty of Medicine, University of Calgary, Alberta, Canada.

^* To whom correspondence should be addressed. E-mail: michael.hill{at}calgaryhealthregion.ca.

Background--Surveillance is necessary to understand and meet the future demands stroke will place on health care. Administrative data are the most accessible data source for stroke surveillance in Canada. The International Classification of Diseases, 10th revision (ICD-10) coding system has potential improvements over ICD-9 for stroke classification. Our purpose was to compare hospital discharge abstract coding using ICD-9 and ICD-10 for stroke and its risk factors.

Methods--We took advantage of a switch in coding systems from ICD-9 to ICD-10 to independently review stroke patient charts. From time periods April 2000 to March 2001, 717 charts, and from April 2002 to March 2003, 249 charts were randomly selected for review. Using a before-and-after time period design, the accuracy of hospital coding of stroke (part I) and stroke risk factors (part II) using ICD-9 and ICD-10 was compared. We used careful definitions of stroke and its types based on ICD-9 using the fourth and fifth digit modifier codes.

Results--Stroke coding was equally good with ICD-9 (90% [CI₉₅ 86 to 93] correct) and ICD-10 [92% (CI₉₅ 88 to 95 correct) with ICD-10. There were some differences in coding by stroke type, notably with transient ischemic attack, but these differences were not statistically significant. Atrial fibrillation, coronary artery disease/ischemic heart disease, diabetes mellitus, and hypertension were coded with high sensitivity (81% to 91%) and specificity (83% to 100%). ICD-10 was as good as ICD-9 for stroke risk factor coding.

Conclusions--Passive surveillance using administrative data are a useful tool for identifying stroke and its risk factors using both ICD-9 and ICD-10.

Key words: epidemiology • health services research • stroke • risk factors

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