子痫前期国际疾病分类规则的修订进展研究  

Research on the Revision of International Classification Rules for Pre-eclampsia

作　　者：周婧雅 张萌 李舒[2] 王怡 Zhou Jingya, Zhang Meng, Li Shu, Wang Yi(Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, Chin)

机构地区：[1]中国医学科学院北京协和医院病案科,北京市100730 [2]中国医学科学院北京协和医院妇产科,北京市100730

出　　处：《中国病案》2018年第3期24-26,共3页Chinese Medical Record

摘　　要：目的了解国际疾病分类中子痫前期编码的最新修订进展,为该编码准确应用提供依据。方法对比ICD-10第二版、世界卫生组织ICD-10 2016在线英文版及ICD-11 Beta版中子痫前期分类规则的异同,并在此基础上检索某三甲医院出院时间为2016年-2017年的所有具有子痫前期和HELLP综合征诊断的病案首页,根据ICD-10 2016在线英文版分类规则重新编码,对比新老编码规则下编码频数的差异。结果 ICD-10 2016英文版和ICD-11 Beta版中类目名称均不再提及"是否伴有有意义的蛋白尿",且均删除了错误分类于"妊娠(引起的)高血压不伴有有意义的蛋白尿"O13类目下的轻度子痫前期,而将其重新归类于"轻度和中度子痫前期"O14.0或JA24.0中;HELLP综合征从重度子痫前期O14.1中分离出来,单独使用编码O14.2或JA24.2表示。新旧规则下子痫前期和HELLP综合征的编码一致率仅为66.0%。结论ICD-10 2016版和ICD-11 Beta版在子痫前期相关条目名称、编码的类目和亚目水平均做了较大幅度修改,应及时修订ICD-10现有版本工具书,保证疾病分类应用与临床实践相适应。Objectives To study the pre-eclampsia coding rulesin the latest versions of International Classification of Diseases, and to provide a basis for more accurate application of the codes. Methods We compared the similarities and differences of pre-eclampsia classification rulesbetween the ICD-10 Second Edition, WHO ICD-10 2016 online English version and ICD-11 Beta version, and then hospital discharge data with pre-eclampsia or HELLP syndrome diagnosis were retrieved using administrative database during 2016 to 2017. We reassigned codes to the diagnoses according to new classification rules of ICD-10 2016 online English version, and frequency of pre-eclampsiarelated codes under the new and old coding rules was compared. Results The ＂significant proteinuria＂ was no longer mentioned in the category title in both ICD-10 2016 English version and ICD-11 Beta version. The originally wrongly classified ＂mild pre-eclampsia＂ was deleted from category O13 Gestational（pregnancy-induced） hypertension without significant proteinuria, and then was reclassified into category of O14.0 or JA24.0 titled ＂mild and moderate pre-eclampsia＂. In addition, HELLP syndrome became independent of severe pre-eclampsia withcode changing from O14.1 to O14.2. After recording under the new rules, the concordance rate of pre-eclampsia and HELLP syndrome codes was only 66%. Conclusions Compared with ICD-10 Second Edition,pre-eclampsia related codes have been substantially revised in category and subcategory levels and accordingly titles both in ICD-10 2016 version and ICD-11 Beta version. Therefore, it was of great necessity to update the existing ICD-10 reference book timely to ensure that the classification rules are finally in line with clinical practice.

关 键 词：子痫前期 ICD-10 ICD-11 修订 

分 类 号：R197.323[医药卫生—卫生事业管理] R714.244[医药卫生—公共卫生与预防医学]