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Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
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Validity of ICD codes to identify do-not-resuscitate orders among older adults with heart failure: A single center

Katherine Callahan1, Yubraj Acharya1, Christopher S Hollenbeak1

  • 1Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, Williamsport, Pennsylvania, United States of America.

Plos One
|March 13, 2023
PubMed

Insights

International Classification of Disease (ICD) codes for do-not-resuscitate (DNR) orders are valid proxies for DNR status in electronic medical records for older heart failure patients. This finding aids advance care planning research using large datasets.

Area of Science:

  • Health Services Research
  • Medical Informatics
  • Geriatric Medicine

Background:

  • Advance care planning (ACP) research is hindered by limited data on ACP variables in large datasets.
  • Electronic medical records (EMR) often lack easily accessible data on critical care decisions.
  • Do-not-resuscitate (DNR) orders are a key component of advance care planning.

Purpose of the Study:

  • To validate International Classification of Disease (ICD) codes as proxies for DNR orders.
  • To assess the accuracy of ICD codes against EMR documentation of DNR orders.
  • To determine the utility of billing codes for identifying DNR status in research.

Main Methods:

  • Study included 5,016 older adults (age >65) with heart failure.
  • DNR orders were identified using ICD-9/ICD-10 codes and manual EMR review.
  • Statistical measures included sensitivity, specificity, predictive values, and agreement (kappa).

Main Results:

  • ICD codes demonstrated high accuracy: 84.6% sensitivity, 96.6% specificity.
  • Positive predictive value was 90.5%, and negative predictive value was 94.3%.
  • A high kappa statistic (0.83) indicated substantial agreement, despite some systematic disagreement.

Conclusions:

  • ICD codes serve as a reliable proxy for DNR orders in hospitalized heart failure patients.
  • This validates the use of billing data for advance care planning research.
  • Further studies are needed to confirm generalizability to other patient populations.
Abstract

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