Department of Pediatrics, Critical Care Section, School of Medicine, University of Colorado, Aurora, Colorado, USA.
Department of Clinical Pharmacy, Center for Pharmaceutical Outcomes (CePOR), Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA.
Pharmacoepidemiol Drug Saf. 2020 Nov;29(11):1499-1503. doi: 10.1002/pds.5001. Epub 2020 Apr 13.
Identify administrative claims-based algorithms for capturing out-of-hospital ventricular arrhythmias (VA) and cardiac arrests (CA) due to cardiac causes in the pediatric population with high positive-predictive value (PPV).
Within a single pediatric center, a retrospective cohort of patients hospitalized or seen in the emergency room for VA or CA were identified from the electronic health records. Eligible encounters were blindly reviewed and linked to administrative data, including ICD-9/ICD-10 codes. Test characteristics, including PPV, for different diagnostic and procedure codes were generated using a 50% training sample. The gold standard was definite or suspected out-of-hospital VA or CA due to cardiac cause verified based on clinical criteria. Algorithms with the highest PPV were then applied to a 50% validation sample to validate performance.
From 2004-2017, 598 encounters met eligibility criteria. 174 (29%) had an outcome of interest, with remainder being an inpatient event or CA due to other cause. Within the training sample (n = 263), VA codes in primary position had a PPV 94% (95%CI 81%-99%) with low sensitivity (44%, 95%CI 33%-56%). CA codes in any position or VA codes in nonprimary positions had low PPV (18%-19%, 31% respectively). Applying the top three performing algorithms to the validation sample (n = 252) yielded similar PPV values.
Contrary to adults, algorithms including a CA code do not perform well for identifying out-of-hospital VA and CA due to cardiac cause in the pediatric populations. Researchers should be aware of the potential implications for future pediatric drug safety studies for these outcomes.
确定基于行政索赔的算法，以捕捉儿科人群中因心脏原因导致的院外室性心律失常（VA）和心脏骤停（CA），并具有较高的阳性预测值（PPV）。
在单个儿科中心内，从电子病历中确定因 VA 或 CA 住院或在急诊室就诊的患者的回顾性队列。对合格的就诊进行盲法审查，并与包括 ICD-9/ICD-10 代码在内的行政数据进行关联。使用 50%的训练样本生成不同诊断和程序代码的测试特征，包括 PPV。金标准是基于临床标准确定的明确或疑似因心脏原因导致的院外 VA 或 CA。然后将具有最高 PPV 的算法应用于 50%的验证样本以验证性能。
2004 年至 2017 年，共有 598 次就诊符合入选标准。其中 174 次（29%）发生了感兴趣的结局事件，其余为住院患者或因其他原因导致的 CA。在训练样本（n=263）中，VA 代码处于主要位置时，PPV 为 94%（95%CI 81%-99%），敏感性较低（44%，95%CI 33%-56%）。任何位置的 CA 代码或非主要位置的 VA 代码的 PPV 均较低（分别为 18%-19%和 31%）。将前三种表现最佳的算法应用于验证样本（n=252）得出了相似的 PPV 值。
与成人不同，包括 CA 代码的算法并不能很好地识别儿科人群中因心脏原因导致的院外 VA 和 CA。研究人员应该意识到这些结果对未来儿科药物安全性研究的潜在影响。
