Validating exacerbations of asthma in electronic health records: a systematic review

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Sensitivity 44.8-91.28% for ICD-9 code 493; >85% for ICD-9 493.xx and ICD-10 J45

• Primary Outcome: Diagnostic accuracy of ICD codes for identifying asthma exacerbations

• Nnt Or Sensitivity: Sensitivity: ICD-9 493 (44.8-91.28%), ICD-9 493.xx (>85%), ICD-10 J45 (>85%); Specificity: >85% for most algorithms

• Confidence Interval: Not reported in abstract

Clinical Application

High - ICD coding is standard practice in healthcare systems Directly applicable to Australian practice as ICD-10-AM is used nationally; relevant for PBS data analysis and RACGP quality improvement initiatives Researchers and clinicians using electronic health records for asthma research and quality improvement

Abstract

BACKGROUND: Previous studies have shown that the algorithms and code lists used to define asthma exacerbations vary across different sources of data, if reported at all. Defining and validating asthma exacerbations in electronic health records (EHR) would help to improve future research on asthma using EHR by leading to more consistent and comparable evidence. METHODS: We systematically reviewed the literature to evaluate studies that define exacerbations of asthma in EHR and report which algorithms have the highest validity. An adapted version of the QUADAS-2 designed for this review was used to assess risk of bias. RESULTS: Of the studies yielded by the search, only five met the inclusion criteria. Eligible studies used algorithms that contained codes from versions or modifications of either the 9th or 10th revisions of the International Statistical Classification of Diseases and Related Health (ICD-9 or ICD-10), and validity scores varied. Using the ICD-9 code 493 within algorithms to detect asthma exacerbations, sensitivity scores varied from 44.8% to 91.28% and specificity was >85%. Using the ICD-9 code 493.xx as the principal and secondary diagnosis in claims data, validity measures were all >85%. Using the ICD-10 code J45, scores for sensitivity, specificity and negative predictive value were also all >85%. CONCLUSIONS: Algorithms have been used to identify asthma exacerbations in EHR with varying degrees of validity. Algorithms including the ICD-9 code 493.xx or the ICD-10 code J45 to detect asthma exacerbations had high validity scores. However, there was a risk of bias in these studies and urgent work is needed using robust methods to validate definitions for future research using EHR.

References

1. 1.Moore, E., Gassasse, Z., Sinha, I., Hawcutt, D. B., & Quint, J. K. (2026). Validating exacerbations of asthma in electronic health records: a systematic review. European Respiratory Review, Article 42203235. https://doi.org/10.1016/j.vaccine.2013.06.091