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Validity of administrative claims-based algorithms for ventricular arrhythmia and cardiac arrest in the pediatric
Angela S Czaja1,2, Kathryn Collins3, Robert J Valuck2
1Department of Pediatrics, Critical Care Section, School of Medicine, University of Colorado, Aurora, Colorado, USA.
Insights
Developing accurate administrative claims algorithms is crucial for identifying pediatric out-of-hospital cardiac arrest (CA) and ventricular arrhythmias (VA). Algorithms using VA codes in the primary position showed high positive-predictive value (PPV) in children.
Area of Science:
- Pediatric Cardiology
- Health Informatics
- Clinical Epidemiology
Background:
- Accurate identification of out-of-hospital cardiac arrest (CA) and ventricular arrhythmias (VA) is essential for pediatric research.
- Administrative claims data offer a valuable resource but require validated algorithms for specific populations.
- Existing algorithms may not be directly applicable to pediatric populations due to unique clinical presentations.
Purpose of the Study:
- To identify administrative claims-based algorithms for capturing pediatric out-of-hospital VA and CA due to cardiac causes.
- To achieve a high positive-predictive value (PPV) for these algorithms in the pediatric population.
Main Methods:
- Retrospective cohort study at a single pediatric center.
- Identification of patients with VA or CA from electronic health records and linkage to administrative data (ICD-9/10 codes).
- Development and validation of algorithms using training and validation samples, with clinical criteria as the gold standard.
Main Results:
- From 2004-2017, 598 eligible encounters were identified; 174 (29%) met outcome criteria.
- VA codes in the primary position demonstrated a high PPV (94%) but low sensitivity (44%) in the training sample.
- CA codes in any position or VA codes in nonprimary positions showed low PPV, similar to validation sample results.
Conclusions:
- Algorithms including CA codes are not effective for identifying pediatric out-of-hospital VA and CA of cardiac origin.
- Findings contrast with adult data and have implications for pediatric drug safety studies.
- Researchers must carefully consider algorithm selection for pediatric outcomes research.
Purpose:
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).
Methods:
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.
Results:
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.
Conclusions:
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.
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