Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, FOT 805D, 510 20th Street South, Birmingham, AL 35294, USA.
Pharmacoepidemiol Drug Saf. 2011 Nov;20(11):1150-8. doi: 10.1002/pds.2215. Epub 2011 Aug 27.
To validate, using physician review of abstracted medical chart data as a gold standard, a claims-based algorithm developed to identify gastrointestinal (GI) perforation cases among rheumatoid arthritis (RA) patients.
Patients with established RA, aged 18 years or older with hospital admissions between January 2004 and September 2009, were selected from a large US-hospital-based database. An algorithm with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes for GI perforation and combinations of GI-related diagnosis codes and Current Procedural Terminology (CPT-4) procedure codes for relevant GI surgeries was used to identify potential GI perforation cases. Two senior experienced specialist physicians independently reviewed abstracted chart data and classified cases as confirmed or unconfirmed GI perforations. Positive predictive values (PPVs) to identify confirmed GI perforation were calculated and stratified by upper versus lower GI tract.
Overall, 86 of 92 GI perforation cases were confirmed, yielding an overall PPV of 94% (95%confidence interval [CI] = 86%-98%). PPV was 100% (95%CI = 100%-100%) for upper GI perforation (esophagus, stomach) and 91% (95%CI = 90%-97%) for lower GI perforation (small intestine, PPV = 100%; large intestine, PPV = 94%; unspecified lower GI, PPV = 89%).
This algorithm, consisting of a combination of ICD-9-CM diagnosis and CPT-4 codes, could be used in future safety studies to evaluate GI perforation risk factors in RA patients.
使用医生对病历数据摘要的审查作为金标准，验证一种旨在识别类风湿关节炎（RA）患者胃肠道（GI）穿孔病例的基于索赔的算法。
从一个大型美国医院数据库中选择了年龄在 18 岁或以上、2004 年 1 月至 2009 年 9 月期间有住院记录的确诊 RA 患者。该算法使用了国际疾病分类，第九版，临床修订版（ICD-9-CM）GI 穿孔诊断代码和 GI 相关诊断代码与相关 GI 手术的当前程序术语（CPT-4）程序代码的组合，以识别潜在的 GI 穿孔病例。两名经验丰富的专家医生独立审查病历摘要数据，并将病例分类为确诊或未确诊的 GI 穿孔。计算了阳性预测值（PPV），以确定确诊的 GI 穿孔，并按上消化道与下消化道进行分层。
总共 92 例 GI 穿孔病例中有 86 例得到确认，总体 PPV 为 94%（95%置信区间[CI] = 86%-98%）。上消化道（食管、胃）穿孔的 PPV 为 100%（95%CI = 100%-100%），下消化道（小肠、PPV = 100%；大肠，PPV = 94%；未指定的下消化道，PPV = 89%）的 PPV 为 91%（95%CI = 90%-97%）。
该算法由 ICD-9-CM 诊断和 CPT-4 代码的组合组成，可在未来的安全性研究中用于评估 RA 患者的 GI 穿孔危险因素。
