Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada.
Paediatric Critical Care Medicine, Children's Hospital, London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada.
Resuscitation. 2022 Feb;171:73-79. doi: 10.1016/j.resuscitation.2021.12.017. Epub 2021 Dec 21.
There is a need for large-scale epidemiological studies of paediatric out-of-hospital cardiac arrest (POHCA). To enable this, we developed and validated international classification of disease (ICD-10) search algorithms for the identification of POHCA patients from health administrative data.
We validated the algorithms with a registry of POHCA (CanRoc) as the reference standard. The reference standard included all atraumatic POHCA in Middlesex-London region for January 2012-June 2020. All algorithms included 1 day to <18-year-old patients transported to emergency department (ED) by ambulance and excluded trauma. We tested three algorithms, which were applied to the National Ambulatory Care Reporting System and Discharge Abstract Database. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ration (NLR) were calculated for each algorithm.
During the study period, 17,688 children presented to the ED by ambulance. The reference standard included 51 POHCA patients. The algorithm using only ICD-10 code for cardiac arrest had a sensitivity of 65.5% and PPV of 90%. The algorithm with the highest sensitivity of 87.3% added sudden infant death syndrome, drowning or asphyxiation with CPR in addition to the cardiac arrest codes for inpatient and ED records. This algorithm had a specificity of 99.9%, PPV of 81.4% and NPV of ∼100.0%.
It is important that algorithms used for cohort identification are validated prior to use. The ICD-10 code for cardiac arrest alone misses many POHCA cases but the use of additional codes can improve the sensitivity while maintaining specificity.
需要对儿科院外心脏骤停（POHCA）进行大规模的流行病学研究。为此，我们开发并验证了国际疾病分类（ICD-10）搜索算法，以便从医疗行政数据中识别 POHCA 患者。
我们使用 POHCA 登记处（CanRoc）作为参考标准来验证算法。参考标准包括 2012 年 1 月至 2020 年 6 月米德尔塞克斯-伦敦地区所有非创伤性 POHCA。所有算法均包括 1 天至<18 岁的患者，由救护车送往急诊室（ED），并排除创伤。我们测试了三种算法，它们应用于国家非住院护理报告系统和出院摘要数据库。为每个算法计算了敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性似然比（PLR）和阴性似然比（NLR）。
在研究期间，有 17688 名儿童通过救护车到 ED 就诊。参考标准包括 51 名 POHCA 患者。仅使用 ICD-10 心脏骤停代码的算法敏感性为 65.5%，PPV 为 90%。具有最高敏感性 87.3%的算法在住院和 ED 记录中添加了婴儿猝死综合征、溺水或窒息伴 CPR 以及心脏骤停代码。该算法的特异性为 99.9%，PPV 为 81.4%，NPV 约为 100.0%。
在使用之前，对用于队列识别的算法进行验证非常重要。单独使用心脏骤停 ICD-10 代码会遗漏许多 POHCA 病例，但使用其他代码可以提高敏感性，同时保持特异性。
