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Use of routinely collected administrative data to define pediatric critical care admission in British Columbia,
Jeffrey N Bone1,2, Ye Shen1, Srinivas Murthy1,3
1BC Children's Hospital Research Institute, Vancouver, Canada.
Introduction:
Administrative health data are essential for quantifying incidence and long-term outcomes associated with pediatric critical illness but rely on reliable capture and coding of hospitalizations with pediatric intensive care unit (PICU) admission. The accuracy of administrative data capture of pediatric critical care admission in Canada is unknown.
Methods:
We assessed the performance of the Discharge Abstract Database (DAD), which captures all hospitalizations in British Columbia, Canada for identifying pediatric critical care admission by comparing records to the Virtual Pediatric Systems (VPS, LLC, Los Angeles, CA), a prospectively collected database of PICU admissions at British Columbia Children's Hospital, British Columbia's only dedicated pediatric quaternary care hospital. We identified all hospitalizations for children younger than 18 years at British Columbia Children's Hospital between 2014 and 2023 and used presence of PICU days in the DAD to identify possible PICU admissions. We then matched the DAD records to the VPS records via exact admission date to determine the performance of this case definition (presence of PICU days) both overall, and across subgroups. We evaluated the accuracy of PICU admission characteristics and outcomes reporting in the DAD using VPS as the reference standard.
Results:
A total of 63,256 admissions were included, of which 8891 had an indicator for PICU admission in the DAD. Of these, 8729 had a positive validation record for PICU admission in the VPS database at British Columbia Children's Hospital. There were 123 admissions to the PICU in the VPS database that were not captured in the DAD. The case definition had excellent sensitivity (96.3%; 95% CI = 95.9, 96.7) and specificity (99.7%; 95% CI = 99.7, 99.7). Results were consistent across subgroups. DAD definitions of admission type, PICU length of stay, inter-hospital transfer status, receipt of invasive mechanical ventilation, and mortality all showed sensitivity and specificity ≥ 85%.
Conclusion:
Using a large validation sample of PICU admissions from a quaternary care centre, we found that routinely collected administrative data on hospitalizations in Canada had high accuracy for classifying and characterizing PICU admissions.
