Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pediatr Infect Dis J. 2011 Mar;30(3):e38-40. doi: 10.1097/INF.0b013e3182027c22.
The incidence of Clostridium difficile infection (CDI) is increasing. Multicenter studies of CDI have been limited by the lack of valid case-finding tools. To facilitate pediatric studies of CDI, we constructed a case-finding tool using administrative data.
A cross-sectional study was performed using the Pediatric Health Information System database and microbiologic data from 4 member hospitals. Using patients with laboratory-confirmed CDI as the standard, we determined the sensitivity, specificity, positive (PPV), and negative (NPV) predictive value of an ICD-9-CM code for identifying children with laboratory-confirmed CDI.
We identified 109 patients with laboratory-confirmed CDI and 119 patients with CDI ICD-9-CM code. The sensitivity, specificity, PPV, and NPV were 80.73%, 99.89%, 73.95%, and 99.92%, respectively, for this comparison. The addition of a billing charge for both C. difficile laboratory test and treatment medication to the ICD-9-CM code increased the specificity and PPV, but resulted in a slight decrease in the sensitivity and NPV. The use of administrative data for identifying pediatric cases of CDI was also compared with that of chart review, and was found to be a stronger surrogate for identifying cases of CDI when compared with microbiology data alone.
These results demonstrate that the use of administrative data for CDI is a reliable and accurate method for identifying pediatric patients with CDI. The use of administrative data could facilitate the completion of larger studies due to its greater accessibility and reduced costs.
艰难梭菌感染（CDI）的发病率正在上升。由于缺乏有效的病例发现工具，多中心 CDI 研究受到限制。为了便于开展儿科 CDI 研究，我们使用管理数据构建了一种病例发现工具。
使用儿科健康信息系统数据库和来自 4 家成员医院的微生物学数据进行了一项横断面研究。以实验室确诊的 CDI 患者为标准，确定了用于识别实验室确诊 CDI 儿童的 ICD-9-CM 代码的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
我们确定了 109 例实验室确诊的 CDI 患者和 119 例具有 CDI ICD-9-CM 代码的患者。比较结果显示，该代码的敏感性、特异性、PPV 和 NPV 分别为 80.73%、99.89%、73.95%和 99.92%。在 ICD-9-CM 代码中添加艰难梭菌实验室检测和治疗药物的计费费用可提高特异性和 PPV，但会导致敏感性和 NPV 略有下降。与微生物学数据相比，使用管理数据识别儿科 CDI 病例也与图表审查进行了比较，结果发现，与单独使用微生物学数据相比，它是识别 CDI 病例的更有力替代方法。
这些结果表明，使用管理数据识别 CDI 是一种可靠且准确的方法，可用于识别患有 CDI 的儿科患者。由于管理数据更容易获得且成本更低，因此使用管理数据可以促进更大规模研究的完成。
