Center for Clinical Epidemiology & Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Pharmacoepidemiol Drug Saf. 2010 Jun;19(6):555-62. doi: 10.1002/pds.1869.
Sudden cardiac death (SD) and ventricular arrhythmias (VAs) caused by medications have arisen as an important public health concern in recent years. The validity of diagnostic codes in identifying SD/VA events originating in the ambulatory setting is not well known. This study examined the positive predictive value (PPV) of hospitalization and emergency department encounter diagnoses in identifying SD/VA events originating in the outpatient setting.
We selected random samples of hospitalizations and emergency department claims with principal or first-listed discharge diagnosis codes indicative of SD/VA in individuals contributing at least 6 months of baseline time within 1999-2002 Medicaid and Medicare data from five large states. We then obtained and reviewed medical records corresponding to these events to serve as the reference standard.
We identified 5239 inpatient and 29 135 emergency department events, randomly selected 100 of each, and obtained 119 medical records, 116 of which were for the requested courses of care. The PPVs for an outpatient-originating SD/VA precipitating hospitalization or emergency department treatment were 85.3% (95% confidence interval [CI] = 77.6-91.2) overall, 79.7% (95%CI = 68.3-88.4) for hospitalization claims, and 93.6% (95%CI = 82.5-98.7) for emergency department claims.
First-listed SD/VA diagnostic codes identified in inpatient or emergency department encounters had very good agreement with clinical diagnoses and functioned well to identify outpatient-originating events. Researchers using such codes can be confident of the PPV when conducting studies of SD/VA originating in the outpatient setting.
近年来，药物引起的心脏性猝死（SD）和室性心律失常（VA）已成为一个重要的公共卫生问题。诊断代码在识别源于门诊环境的 SD/VA 事件的有效性尚不清楚。本研究检查了住院和急诊就诊诊断在识别源于门诊环境的 SD/VA 事件中的阳性预测值（PPV）。
我们从五个大州的 1999-2002 年 Medicaid 和 Medicare 数据中选择了具有表明 SD/VA 的主要或第一列出的出院诊断代码的住院和急诊就诊的随机样本，这些个体在基线至少 6 个月内有贡献。然后，我们获得并审查了与这些事件相对应的医疗记录，作为参考标准。
我们确定了 5239 例住院和 29135 例急诊事件，随机选择了每种情况下的 100 例，并获得了 119 份病历，其中 116 份是为请求的治疗过程提供的。门诊起源的 SD/VA 引发住院或急诊治疗的 PPV 总体为 85.3%（95%置信区间[CI] = 77.6-91.2），住院索赔为 79.7%（95%CI = 68.3-88.4），急诊索赔为 93.6%（95%CI = 82.5-98.7）。
住院或急诊就诊中首次列出的 SD/VA 诊断代码与临床诊断具有非常好的一致性，并且可以很好地识别门诊起源的事件。当在门诊环境中进行 SD/VA 的研究时，使用此类代码的研究人员可以对 PPV 充满信心。
