Kawai Vivian K, Murray Katherine T, Stein C Michael, Cooper William O, Graham David J, Hall Kathi, Ray Wayne A
Division of Pharmacoepidemiology, Department of Preventive Medicine, Nashville, TN, USA.
BMC Res Notes. 2012 Aug 31;5:473. doi: 10.1186/1756-0500-5-473.
To facilitate the use of automated databases for studies of sudden cardiac death, we previously developed a computerized case definition that had a positive predictive value between 86% and 88%. However, the definition has not been specifically validated for prescription opioid users, for whom out-of-hospital overdose deaths may be difficult to distinguish from sudden cardiac death.
We assembled a cohort of persons 30-74 years of age prescribed propoxyphene or hydrocodone who had no life-threatening non-cardiovascular illness, diagnosed drug abuse, residence in a nursing home in the past year, or hospital stay within the past 30 days. Medical records were sought for a sample of 140 cohort deaths within 30 days of a prescription fill meeting the computer case definition. Of the 140 sampled deaths, 81 were adjudicated; 73 (90%) were sudden cardiac deaths. Two deaths had possible opioid overdose; after removing these two the positive predictive value was 88%.
These findings are consistent with our previous validation studies and suggest the computer case definition of sudden cardiac death is a useful tool for pharmacoepidemiologic studies of opioid analgesics.
为便于利用自动化数据库开展心脏性猝死研究，我们之前制定了一种计算机化病例定义，其阳性预测值在86%至88%之间。然而，该定义尚未针对处方阿片类药物使用者进行专门验证，对于这类人群，院外过量用药死亡可能难以与心脏性猝死区分开来。
我们选取了一组年龄在30至74岁之间、开具了丙氧芬或氢可酮处方且无危及生命的非心血管疾病、无确诊药物滥用情况、过去一年未居住在养老院且过去30天内未住院的人群。对于在满足计算机病例定义的处方配药后30天内死亡的140名队列成员的样本，我们查找了其医疗记录。在这140例抽样死亡病例中，81例进行了判定；73例（90%）为心脏性猝死。有两例死亡可能是阿片类药物过量；去除这两例后，阳性预测值为88%。
这些结果与我们之前的验证研究一致，表明心脏性猝死的计算机病例定义是阿片类镇痛药药物流行病学研究的有用工具。
