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Chart validation of inpatient ICD-9-CM administrative diagnosis codes for ischemic stroke among IGIV users in the Sentinel Distributed Database.
Medicine (Baltimore). 2017 Dec; 96(52):e9440.M

Abstract

The Sentinel Distributed Database (SDD) is a large database of patient-level medical and prescription records, primarily derived from insurance claims and electronic health records, and is sponsored by the U.S. Food and Drug Administration for drug safety assessments. In this chart validation study, we report on the positive predictive value (PPV) of inpatient ICD-9-CM acute ischemic stroke (AIS) administrative diagnosis codes (433.x1, 434.xx, and 436) in the SDD.As part of an assessment of the risk of thromboembolic adverse events following treatment with intravenous immune globulin (IGIV), charts were obtained for 131 potential post-IGIV AIS cases. Charts were abstracted by trained nurses and then adjudicated by stroke experts using pre-specified diagnostic criteria.Case status could be determined for 128 potential AIS cases, of which 34 were confirmed. The PPVs for the inpatient AIS diagnoses recorded in the SDD were 27% overall [95% confidence interval (95% CI): 19-35], 60% (95% CI: 32-84) for principal-position diagnoses, 42% (95% CI: 28-57) for secondary diagnoses, and 6% (95% CI: 2-15) for position-unspecified diagnoses (which in the SDD generally originate from separate physician claims associated with an inpatient stay).Position-unspecified diagnoses were unlikely to represent true AIS cases. PPVs for principal and secondary inpatient diagnosis codes were higher, but still meaningfully lower than estimates from prior chart validation studies. The low PPVs may be specific to the IGIV user study population. Additional research is needed to assess the validity of AIS administrative diagnosis codes in other study populations within the SDD.

Authors+Show Affiliations

College of Public Health, University of Iowa, Iowa City, IA Carver College of Medicine, University of Iowa, Iowa City, IA Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD Iowa City VA Health Care System, Iowa City, IA Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29384925

Citation

Ammann, Eric M., et al. "Chart Validation of Inpatient ICD-9-CM Administrative Diagnosis Codes for Ischemic Stroke Among IGIV Users in the Sentinel Distributed Database." Medicine, vol. 96, no. 52, 2017, pp. e9440.
Ammann EM, Leira EC, Winiecki SK, et al. Chart validation of inpatient ICD-9-CM administrative diagnosis codes for ischemic stroke among IGIV users in the Sentinel Distributed Database. Medicine (Baltimore). 2017;96(52):e9440.
Ammann, E. M., Leira, E. C., Winiecki, S. K., Nagaraja, N., Dandapat, S., Carnahan, R. M., Schweizer, M. L., Torner, J. C., Fuller, C. C., Leonard, C. E., Garcia, C., Pimentel, M., & Chrischilles, E. A. (2017). Chart validation of inpatient ICD-9-CM administrative diagnosis codes for ischemic stroke among IGIV users in the Sentinel Distributed Database. Medicine, 96(52), e9440. https://doi.org/10.1097/MD.0000000000009440
Ammann EM, et al. Chart Validation of Inpatient ICD-9-CM Administrative Diagnosis Codes for Ischemic Stroke Among IGIV Users in the Sentinel Distributed Database. Medicine (Baltimore). 2017;96(52):e9440. PubMed PMID: 29384925.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chart validation of inpatient ICD-9-CM administrative diagnosis codes for ischemic stroke among IGIV users in the Sentinel Distributed Database. AU - Ammann,Eric M, AU - Leira,Enrique C, AU - Winiecki,Scott K, AU - Nagaraja,Nandakumar, AU - Dandapat,Sudeepta, AU - Carnahan,Ryan M, AU - Schweizer,Marin L, AU - Torner,James C, AU - Fuller,Candace C, AU - Leonard,Charles E, AU - Garcia,Crystal, AU - Pimentel,Madelyn, AU - Chrischilles,Elizabeth A, PY - 2018/2/1/entrez PY - 2018/2/1/pubmed PY - 2018/2/10/medline SP - e9440 EP - e9440 JF - Medicine JO - Medicine (Baltimore) VL - 96 IS - 52 N2 - The Sentinel Distributed Database (SDD) is a large database of patient-level medical and prescription records, primarily derived from insurance claims and electronic health records, and is sponsored by the U.S. Food and Drug Administration for drug safety assessments. In this chart validation study, we report on the positive predictive value (PPV) of inpatient ICD-9-CM acute ischemic stroke (AIS) administrative diagnosis codes (433.x1, 434.xx, and 436) in the SDD.As part of an assessment of the risk of thromboembolic adverse events following treatment with intravenous immune globulin (IGIV), charts were obtained for 131 potential post-IGIV AIS cases. Charts were abstracted by trained nurses and then adjudicated by stroke experts using pre-specified diagnostic criteria.Case status could be determined for 128 potential AIS cases, of which 34 were confirmed. The PPVs for the inpatient AIS diagnoses recorded in the SDD were 27% overall [95% confidence interval (95% CI): 19-35], 60% (95% CI: 32-84) for principal-position diagnoses, 42% (95% CI: 28-57) for secondary diagnoses, and 6% (95% CI: 2-15) for position-unspecified diagnoses (which in the SDD generally originate from separate physician claims associated with an inpatient stay).Position-unspecified diagnoses were unlikely to represent true AIS cases. PPVs for principal and secondary inpatient diagnosis codes were higher, but still meaningfully lower than estimates from prior chart validation studies. The low PPVs may be specific to the IGIV user study population. Additional research is needed to assess the validity of AIS administrative diagnosis codes in other study populations within the SDD. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/29384925/Chart_validation_of_inpatient_ICD_9_CM_administrative_diagnosis_codes_for_ischemic_stroke_among_IGIV_users_in_the_Sentinel_Distributed_Database_ L2 - https://doi.org/10.1097/MD.0000000000009440 DB - PRIME DP - Unbound Medicine ER -