Accurate diagnosis of bullous pemphigoid requires multiple health care visits

Päivi Leisti; Anna Pankakoski; Jari Jokelainen; Outi Varpuluoma; Laura Huilaja; Jaana Panelius; Kaisa Tasanen

doi:10.3389/fimmu.2023.1281302

Frontiers in Immunology (Nov 2023)

Accurate diagnosis of bullous pemphigoid requires multiple health care visits

Päivi Leisti,
Anna Pankakoski,
Jari Jokelainen,
Outi Varpuluoma,
Laura Huilaja,
Jaana Panelius,
Kaisa Tasanen

Affiliations

Päivi Leisti: Department of Dermatology, Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
Anna Pankakoski: Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Jari Jokelainen: Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
Outi Varpuluoma: Department of Dermatology, Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
Laura Huilaja: Department of Dermatology, Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
Jaana Panelius: Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Kaisa Tasanen: Department of Dermatology, Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland

DOI: https://doi.org/10.3389/fimmu.2023.1281302
Journal volume & issue: Vol. 14

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IntroductionAccurate use of diagnostic codes is crucial for epidemiological and genetic research based on electronic health record (EHR) data. MethodsThis retrospective study validated the International Classification of Diseases (ICD)-10 diagnostic code L12.0 for bullous pemphigoid (BP) using EHR data from two Finnish university hospitals. We found 1225 subjects with at least one EHR entry of L12.0 between 2009 and 2019. BP diagnosis was based on clinical findings characteristic of BP and positive findings on direct immunofluorescence (DIF), BP180-NC16A enzyme-linked immunosorbent assay (ELISA) or indirect immunofluorescence (IIF) assay. ResultsTrue BP was found in 901 patients; the positive predictive value (PPV) for L12.0 was 73.6% (95% CI 71.0-76.0). L12.0 was more accurately registered in dermatology units than any specialized health care units (p<0.001). Including patients with multiple L12.0 registrations (≥3), increased the accuracy of the L12.0 code in both dermatology units and other settings.DiscussionOne diagnostic code of L12.0 is not enough to recognize BP in a large epidemiological data set; including only L12.0 registered in dermatology units and excluding cases with <3 L12.0 record entries markedly increases the PPV of BP diagnosis.

Published in Frontiers in Immunology

ISSN: 1664-3224 (Online)
Publisher: Frontiers Media S.A.
Country of publisher: Switzerland
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: http://journal.frontiersin.org/journal/immunology

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