Accuracy of venous thromboembolism ICD-10 codes: A systematic review and meta-analysis

Aims The identification of venous thromboembolism (VTE) using administrative databases is frequently required for reporting and research. The accuracy of International Classification of Diseases 10th revision (ICD-10) codes for VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE), remains unclear. We examined the accuracy of ICD-10 codes for identifying VTE in adult and pediatric inpatients and outpatients. Methods For this systematic review and meta-analysis, we searched MEDLINE, EMBASE, Web of Science, CENTRAL, Epistemonikos and McMaster Superfilters from inception to July 25, 2023 for studies evaluating the sensitivity, specificity, positive predictive value (PPV), and/or negative predictive value (NPV) of ICD-10 codes for VTE in any anatomical location. We assessed risk of bias using QUADAS and certainty of evidence using GRADE. We calculated pooled sensitivity and specificity with 95% confidence intervals (CI) using a random-effects model. Results We included 24 studies in the qualitative synthesis and 7 in the meta-analysis. Pooled sensitivity for any VTE based on ICD-10 codes was 72% (95% CI 60–85%, low certainty); pooled specificity was 82% (95% CI 76–88%, low certainty). The PPV for ICD-10 VTE codes ranged from 0% to 100% (median: 80%) while the NPV ranged from 95.4% to 100% (median: 100%). ICD-10 codes for PE had a higher pooled sensitivity (91%) than for DVT (58%). Conclusion ICD-10 codes have moderate-to-high sensitivity and specificity for the identification of VTE in electronic databases. The certainty of evidence is low due to inconsistency and risk of bias. Further robust studies validating ICD-10 VTE codes are needed to improve reporting and better understand coding limitations.