Acute coronary syndrome cohort definition: troponin versus ICD-9-CM codes
Sandip R Vaidya1, Jason S Shapiro, Paris B Lovett
1Columbia University Medical Center, 622 West 168th Street, NY 10032, USA.
Insights
Troponin lab results accurately identify acute coronary syndrome (ACS) rule-out patients in emergency departments, outperforming billing codes. This clinical data is faster and more reliable for research cohort identification.
Area of Science:
- Emergency Medicine
- Clinical Pathology
- Health Informatics
Background:
- Accurate identification of patients with acute coronary syndrome (ACS) rule-out (R/O) is crucial for emergency department (ED) care.
- Traditional methods rely on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, which may have limitations in timeliness and accuracy.
Purpose of the Study:
- To compare the accuracy of troponin laboratory results against ICD-9-CM codes for identifying ACS R/O patients in the ED.
- To evaluate the efficiency and reliability of clinical data versus billing data for patient cohort identification.
Main Methods:
- A retrospective analysis of emergency department patient data was performed.
- Chart reviews established a gold standard for ACS R/O identification.
- Patients with at least two troponin tests within 24 hours and those with relevant ICD-9-CM codes were identified from a clinical data warehouse.
Main Results:
- Troponin testing demonstrated 100% sensitivity and 95.51% specificity in identifying ACS R/O patients.
- ICD-9-CM codes identified 13 out of 17 gold-standard ACS R/O patients, with 76.47% sensitivity and 93.91% specificity.
- Clinical data (troponins) proved more sensitive and specific than billing codes (ICD-9-CM) for this patient cohort.
Conclusions:
- Troponin laboratory results are a more accurate and timely method for identifying acute coronary syndrome rule-out patients compared to ICD-9-CM codes.
- Clinical data, such as serial troponin measurements, offers a reliable approach for identifying specific patient cohorts for clinical research.
- The findings suggest a broader applicability of using clinical data for disease-specific cohort identification in research settings.
Aim:
To determine the accuracy of troponin laboratory results versus International Classification of Diseases clinical modification codes (ICD-9-CM) in identifying acute coronary syndrome (ACS) rule-out (R/O) patients who present to emergency departments (EDs).
Materials & Methods:
Retrospective data analysis and chart review (to establish gold standard) were conducted on ED patients. Data retrieved from a clinical data warehouse were reviewed to identify patients with two or more troponins within 24 h of ED registration and ICD-9-CM codes consistent with ACS R/O.
Results:
Of 329 charts reviewed, 17 were determined to be ACS R/O. A total of 31 out of 329 (9.42%, 95% CI: 6.26–12.58%) had two or more troponins with a sensitivity of 100% (95% CI: 77.08–100%) and specificity of 95.51% (95% CI: 92.42–97.43%). A total of 32 out of 329 patients (9.73%, 95% CI: 6.53–12.93%) had R/O ICD-9-CM codes with a sensitivity of 76.47% (95% CI: 49.76–83.00%) and specificity of 93.91% (95% CI: 90.50–96.19%). All 17 gold-standard ACS R/O patients were identified using troponins while ICD-9-CM identified 13 out of 17.
Conclusion:
Clinical data (two troponins) availability is timelier and compares well with billing data (ICD-9-CM codes) in ACS R/O patient identification. Clinical data use may be generalized to identify other disease specific cohorts for clinical research.
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