White Richard H, Sadeghi Banafsheh, Tancredi Daniel J, Zrelak Patricia, Cuny Joanne, Sama Pradeep, Utter Garth H, Geppert Jeffrey J, Romano Patrick S
Division of General Medicine, University of California, Davis, CA 95817, USA.
Med Care. 2009 Dec;47(12):1237-43. doi: 10.1097/MLR.0b013e3181b58940.
Hospital administrative data are being used to identify patients with postoperative venous thromboembolism (VTE), either pulmonary embolism (PE) or deep-vein thrombosis (DVT). However, few studies have evaluated the accuracy of these ICD-9-CM codes across multiple hospitals.
The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI)-12 was used to identify cases with postoperative VTE in 80 hospitals that volunteered for either an AHRQ or University HealthSystem Consortium (UHC) validation project. Trained abstractors using a standardized tool and guidelines retrospectively verified all coded VTE events.
In the combined samples, the positive predictive value of the set of prespecified VTE codes for any acute VTE at any time during the hospitalization was 451 of 573 = 79% (95% CI: 75%-82%). However, the positive predictive value for acute lower extremity DVT or PE diagnosed after an operation was 209 of 452 = 44% (95% CI: 37%-51%) in the UHC sample and 58 of 121 = 48% (95% CI: 42-67%) in the AHRQ sample. Fourteen percent of all cases had an acute upper extremity DVT, 6% had superficial vein thrombosis and 21% had no acute VTE, however, 61% of the latter had a documented prior/chronic VTE. In the UHC cohort, the sensitivity for any acute VTE was 95.5% (95% CI: 86.4%-100%); the specificity was 99.5% (95% CI: 99.4%-99.7%).
Current PSI 12 criteria do not accurately identify patients with acute postoperative lower extremity DVT or PE. Modification of the ICD-9-CM codes and implementation of "present on admission" flags should improve the predictive value for clinically important VTE events.
医院管理数据正被用于识别术后发生静脉血栓栓塞症（VTE）的患者，包括肺栓塞（PE）或深静脉血栓形成（DVT）。然而，很少有研究评估这些国际疾病分类第九版临床修正版（ICD-9-CM）编码在多家医院中的准确性。
医疗保健研究与质量局（AHRQ）患者安全指标（PSI）-12被用于在80家自愿参与AHRQ或大学卫生系统联盟（UHC）验证项目的医院中识别术后VTE病例。经过培训的提取人员使用标准化工具和指南对所有编码的VTE事件进行回顾性核实。
在合并样本中，预先指定的VTE编码组对住院期间任何时间发生的任何急性VTE的阳性预测值为573例中的451例 = 79%（95%可信区间：75%-82%）。然而，在UHC样本中，术后诊断的急性下肢DVT或PE的阳性预测值为452例中的209例 = 44%（95%可信区间：37%-51%），在AHRQ样本中为121例中的58例 = 48%（95%可信区间：42%-67%）。所有病例中有14%发生急性上肢DVT，6%发生浅静脉血栓形成，21%没有急性VTE，然而，后者中有61%有既往/慢性VTE记录。在UHC队列中，对任何急性VTE的敏感性为95.5%（95%可信区间：86.4%-100%）；特异性为99.5%（95%可信区间：99.4%-99.7%）。
当前的PSI 12标准不能准确识别急性术后下肢DVT或PE患者。修改ICD-9-CM编码并实施“入院时存在”标志应能提高对临床上重要的VTE事件的预测价值。
