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External Validation of ASPECT (Algorithm for Suspected Pulmonary Embolism Confirmation and Treatment)
Adi J Klil-Drori1,2, Dwip Prajapati3, Zhiying Liang4
1Center for Clinical Epidemiology, Jewish General Hospital.
Medical Care
|January 5, 2019
Summary
The ASPECT algorithm significantly improves the accuracy of identifying pulmonary embolism (PE) in administrative health databases. This validated tool enhances research reliability by combining diagnoses, imaging, and prescriptions for confirmed PE cases.
Area of Science:
- Health Informatics
- Epidemiology
- Medical Record Analysis
Background:
- Administrative health databases are crucial for studying pulmonary embolism (PE).
- Single PE codes in these databases have shown variable validity.
- The ASPECT algorithm was developed to improve PE ascertainment using multiple data sources.
Purpose of the Study:
- To externally validate the ASPECT algorithm using independent administrative health care databases.
- To assess the accuracy of ASPECT in identifying confirmed pulmonary embolism cases.
- To compare ASPECT's performance against single PE codes and multi-component combinations.
Main Methods:
- Utilized electronic health records from Calgary emergency departments (EDs) for patient identification (Jan-June 2016).
- Applied ASPECT by integrating ED diagnoses, linked hospital admission data, and pharmacy records.
- Validated ASPECT's confirmed PE against chart reviews within ED electronic health records.
Main Results:
- The cohort comprised 498 patients; 327 had confirmed PE.
- ASPECT achieved a positive predictive value of 96.5%, significantly higher than single PE codes (65.6%).
- Overall agreement between ASPECT and confirmed PE was 92.2%, demonstrating robustness in both inpatient and outpatient settings.
Conclusions:
- Single administrative codes for PE are limited in their validity.
- The ASPECT algorithm is a reliable and acceptable tool for studying pulmonary embolism in administrative health data.
- ASPECT offers improved precision compared to two-component combinations.
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