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Validation of Administrative Codes for Palliative Care Consultation Among Critically Ill Children

Siobhán O'Keefe1, Angela S Czaja2

  • 1Department of Paediatric Critical Care, Children's Health Ireland, Dublin, Ireland; and.

Hospital Pediatrics
|January 29, 2021
PubMed

Insights

Palliative care (PC) administrative codes for critically ill children show high accuracy (specificity) but frequently miss actual PC cases (low sensitivity). Researchers should consider this underascertainment in future studies using administrative data.

Area of Science:

  • Pediatric Critical Care Medicine
  • Health Services Research
  • Medical Informatics

Background:

  • Accurate identification of palliative care (PC) utilization is crucial for resource allocation and quality improvement in pediatric intensive care units (PICUs).
  • Administrative codes are often used to track healthcare services, but their validity in specific patient populations requires careful evaluation.

Purpose of the Study:

  • To assess the accuracy of administrative codes (V66.7 and Z51.5) for identifying palliative care consultations in critically ill children.
  • To determine the sensitivity, specificity, and predictive values of these codes against a local PC registry.

Main Methods:

  • A single-center retrospective cohort study analyzed hospitalizations with PICU admission from March 2016 to March 2018.
  • Palliative care administrative codes were compared against a gold standard local PC registry.
  • Key performance metrics including sensitivity, specificity, and predictive values were calculated.

Main Results:

  • The study included 4670 hospitalizations; 3.9% had documented PC consultations.
  • Palliative care administrative codes demonstrated high specificity (99.8%) but low sensitivity (11%).
  • Positive predictive value was 66.7% and negative predictive value was 96.5%.

Conclusions:

  • Current administrative codes for palliative care in critically ill children are highly specific but have poor sensitivity, indicating significant underascertainment.
  • Future research utilizing administrative data should account for the limitations in capturing PC utilization in this population.
Abstract

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