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The validity of hospital diagnostic and procedure codes reflecting morbidity in preterm neonates born <32 weeks
Kelli K Ryckman1,2, Paul J Holdefer3,4, Eva Sileo3
1Department of Epidemiology, University of Iowa, Iowa City, IA, USA. kryckman@iu.edu.
Objective:
To determine the validity of diagnostic hospital billing codes for complications of prematurity in neonates <32 weeks gestation.
Study Design:
Retrospective cohort data from discharge summaries and clinical notes (n = 160) were reviewed by trained, blinded abstractors for the presence of intraventricular hemorrhage (IVH) grades 3 or 4, periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), stage 3 or higher, retinopathy of prematurity (ROP), and surgery for NEC or ROP. Data were compared to diagnostic billing codes from the neonatal electronic health record.
Results:
IVH, PVL, ROP and ROP surgery had strong positive predictive values (PPV > 75%) and excellent negative predictive values (NPV > 95%). The PPVs for NEC (66.7%) and NEC surgery (37.1%) were low.
Conclusion:
Diagnostic hospital billing codes were observed to be a valid metric to evaluate preterm neonatal morbidities and surgeries except in the instance of more ambiguous diagnoses such as NEC and NEC surgery.
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