Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
BMJ Qual Saf. 2018 Dec;27(12):982-988. doi: 10.1136/bmjqs-2017-007715. Epub 2018 May 25.
Central line associated pneumothorax (CLAP) could be a good quality of care indicator because they are objectively measured, clearly undesirable and possibly avoidable. We measured the incidence and trends of CLAP using radiograph report text search with manual review and compared them with measures using routinely collected health administrative data.
For each hospitalisation to a tertiary care teaching hospital between 2002 and 2015, we searched all chest radiography reports for a central line with a sensitive computer algorithm. Screen positive reports were manually reviewed to confirm central lines. The index and subsequent chest radiography reports were screened for pneumothorax followed by manual confirmation. Diagnostic and procedural codes were used to identify CLAP in administrative data.
In 685 044 hospitalisations, 10 819 underwent central line insertion (1.6%) with CLAP occurring 181 times (1.7%). CLAP risk did not change over time. Codes for CLAP were inaccurate (sensitivity 13.8%, positive predictive value 6.6%). However, overall code-based CLAP risk (1.8%) was almost identical to actual values possibly because patient strata with inflated CLAP risk were balanced by more common strata having underestimated CLAP risk. Code-based methods inflated central line incidence 2.2 times and erroneously concluded that CLAP risk decreased significantly over time.
Using valid methods, CLAP incidence was similar to those in the literature but has not changed over time. Although administrative database codes for CLAP were very inaccurate, they generated CLAP risks very similar to actual values because of offsetting errors. In contrast to those from radiograph report text search with manual review, CLAP trends decreased significantly using administrative data. Hospital CLAP risk should not be measured using administrative data.
中心静脉置管相关气胸（CLAP）可以作为医疗质量的一个良好指标，因为它是客观测量的，显然是不期望的，而且可能是可以避免的。我们使用放射报告文本搜索进行人工审查，测量了 CLAP 的发生率和趋势，并将其与使用常规收集的健康管理数据进行了比较。
对于 2002 年至 2015 年期间在一家三级教学医院的每次住院，我们使用敏感的计算机算法搜索所有胸部 X 光报告中的中央线。对阳性筛查报告进行人工审查，以确认中央线。对索引和随后的胸部 X 光报告进行筛查，以确认有无气胸，然后进行人工确认。使用诊断和程序代码在管理数据中识别 CLAP。
在 685044 例住院患者中，有 10819 例行中央线置管（1.6%），其中 181 例发生 CLAP（1.7%）。CLAP 风险并未随时间而改变。CLAP 的代码不准确（敏感性 13.8%，阳性预测值 6.6%）。然而，基于代码的总体 CLAP 风险（1.8%）几乎与实际值相同，这可能是因为具有膨胀的 CLAP 风险的患者分层被低估的 CLAP 风险的更常见分层所平衡。基于代码的方法使中央线的发生率增加了 2.2 倍，并错误地得出结论认为 CLAP 的风险随时间显著降低。
使用有效方法，CLAP 的发生率与文献中的相似，但并未随时间而改变。尽管 CLAP 的管理数据库代码非常不准确，但由于抵消错误，它们生成的 CLAP 风险与实际值非常相似。与放射报告文本搜索和人工审查的结果相比，使用管理数据，CLAP 趋势显著下降。医院不应使用管理数据来衡量 CLAP 风险。
