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An Administrative Data-based Surrogate Definition Identifies Children Evaluated Beyond Physical Examination for
Eric W Glissmeyer1,2, Sydney Ryan1, Nanette C Dudley1
1Department of Pediatrics, University of Utah, Salt Lake City, Utah.
Insights
Researchers developed a method to identify children evaluated for appendicitis using administrative data. This approach helps track patients who undergo extensive testing but do not have appendicitis, aiding quality improvement research.
Area of Science:
- Pediatric emergency medicine
- Health informatics
- Clinical research methodology
Background:
- Identifying all patients evaluated for appendicitis, especially those without the condition, is challenging.
- Administrative data offers a potential solution for identifying these complex cases.
Purpose of the Study:
- To develop and validate a surrogate definition for identifying children evaluated for suspected appendicitis using administrative data.
- To enable retrospective research on quality improvement and healthcare resource utilization in pediatric appendicitis evaluations.
Main Methods:
- A multidisciplinary team defined "suspected appendicitis" using administrative data criteria: ultrasonography or abdominal pain with CBC and "appendicitis" in the provider note.
- The surrogate definition's performance was evaluated against manual chart review.
Main Results:
- The surrogate definition achieved high performance characteristics: 79.8% sensitivity, 96.3% specificity, 83.3% PPV, and 95.3% NPV compared to chart review.
- Of patients evaluated beyond physical exam, 39% underwent appendectomy.
Conclusions:
- Administrative data and keyword searches can reliably identify children evaluated for appendicitis.
- This method supports research into quality improvement and resource utilization for suspected appendicitis cases.
Abstract:
Previous studies have reported on the evaluation of patients diagnosed with appendicitis. Very little is known about all patients evaluated for suspected appendicitis. Patients evaluated beyond physical examination with laboratory and imaging testing, then found not to have appendicitis, are more difficult to identify. Data readily available in administrative databases may be used to identify these patients.
Methods:
A multidisciplinary team developed a surrogate definition for evaluating suspected appendicitis in children based on available administrative data. Appendicitis was "suspected" if the patient underwent ultrasonography of the appendix or had a chief complaint of abdominal pain with both complete blood count performed and the word "appendicitis" in the ED provider note. Performance characteristics described the surrogate definition's ability to retrospectively identify patients evaluated for suspected appendicitis through comparison to a population identified via chart review.
Results:
Compared with manual chart review of 498 patients from June 2014, the surrogate definition identified patients evaluated beyond physical examination for suspected appendicitis with a sensitivity of 79.8%, a specificity of 96.3%, a positive predictive value of 83.3%, and a negative predictive value of 95.3%. Of the 94 patients evaluated beyond physical examination for suspected appendicitis, 37 (39%) underwent appendectomy.
Conclusions:
Health systems can retrospectively identify children evaluated beyond physical examination for appendicitis using discrete administrative data and a word search of clinical notes. This surrogate definition for evaluation of suspected appendicitis enables research in quality improvement efforts and health care resource utilization.
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