Diagnostic accuracy of the international classification of disease "I26" code to detect acute pulmonary embolism in a surveillance network.

Background: Emergency departments (EDs) offer a unique platform for a surveillance network for acute pulmonary embolism (PE) using International Classification of Disease (ICD-10) codes extracted from electronic medical records. Objectives: Test the diagnostic accuracy of the I26 "leader" ICD-10 code for the detection of PE in near real-time in a large, ED-based surveillance network. Methods: Standardized structured language queries were deployed at 91 hospitals to extract data, including ICD-10 codes, on a weekly basis from electronic medical records on ED patients with acute respiratory complaints. We used 2 methods for coding computed tomography pulmonary angiogram (CTPA) reports to derive a criterion or gold standard for PE diagnosis: (1) research associates were trained to interpret the CTPA reports, and (2) a validated Regular Expression computer program was used to interpret PE on CTPA reports. These 2 methods were independently adjudicated (PE Results: From 6448 valid CTPA scan reports, 442 (6.8%) were adjudicated as PE Conclusion: For low-latency surveillance of PE diagnosed in EDs, the ICD leader code I26 affords high specificity and high LR(+) for detection of acute PE in the United States but has modest sensitivity.