Validation of ICD-10 Codes for Severe Maternal Morbidity at Delivery in a Public Hospital

Epidemiology. 2024 Jul 1;35(4):506-511. doi: 10.1097/EDE.0000000000001743. Epub 2024 Mar 29.


Background: Severe maternal morbidity is a composite measure of serious obstetric complications that is often identified in administrative data using the International Classification of Diseases (ICD) diagnosis and procedure codes for a set of 21 indicators. Prior studies of screen-positive cases have demonstrated low predictive value for ICD codes relative to the medical record. To our knowledge, the validity of ICD-10 codes for identifying severe maternal morbidity has not been fully described.

Methods: We estimated the sensitivity, specificity, positive predictive value, and negative predictive value of ICD-10 codes for severe maternal morbidity occurring at delivery, compared with medical record abstraction (gold standard), for 1,000 deliveries that took place during 2016-2018 at a large, public hospital.

Results: We identified a total of 67 cases of severe maternal morbidity using the ICD-10 definition and 74 cases in the medical record. The sensitivity was 26% (95% confidence interval [CI] = 16%, 37%), the positive predictive value was 28% (95% CI = 18%, 41%), the specificity was 95% (95% CI = 93%, 96%), and the negative predictive value was 94% (95% CI = 92%, 96%).

Conclusions: The validity of ICD-10 codes for severe maternal morbidity in our high-burden population was poor, suggesting considerable potential for bias.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Delivery, Obstetric / statistics & numerical data
  • Female
  • Hospitals, Public* / statistics & numerical data
  • Humans
  • International Classification of Diseases*
  • Medical Records
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy Complications / epidemiology
  • Sensitivity and Specificity*
  • Young Adult