Methods: RSV was identified on nasopharyngeal and throat swabs (NPS) using indirect fluorescent antibody (IFA) in 17 symptomatic patients and confirmed by viral culture in 14/17. Patient age was 43 Ϯ 15(18 -63) years, m:f ϭ10:7, single: bilateral LTX ϭ 5:12, post-op 1444Ϯ1272(61-4598) days . Underlying diagnoses included cystic fibrosis (8), emphysema (7) and pulmonary fibrosis (2). All 17 received intravenous ribavirin (33 mg/kg on day 1 and 20 mg/kg/day thereafter in 3 divided doses) with oral prednisolone (1mg/kg) until repeat NPS were negative for RSV on IFA. Median therapy was 8(6 -14) days. Results: There was no mortality. No patient developed BOS. FEV 1 fell from 2.1Ϯ1.0L(0.7-3.7) to 1.8Ϯ0.9L(0.5-3.6) (pϽ0.001) but recovered to 2.1Ϯ 0.9(0.7-3.7) within 2 months and was maintained at a follow-up of 361Ϯ321(10 -838) days. Complications included mild hemolytic anemia (Hb fell from 124Ϯ21g/l(84 -154) to 107Ϯ18g/l(75-138): pϭ0.005). Cost savings were $US13,811/ case versus nebulised therapy at 6gm/d (pϽ0.001). Conclusions: This is the largest series of treated RSV cases after LTX and the first to show that IV ribavirin and oral corticosteroids is well tolerated and effective in reducing RSV related complications after LTX. Cost-utility is established versus nebulised therapy. Early diagnosis and management are integral to the efficacy of treatment to prevent severe airway epithelial injury and the sequelae of BOS.

Background The Centers for Disease Control and Prevention's Surveillance of Congenital Heart Defects Across the Lifespan project uses large clinical and administrative databases at sites throughout the United States to understand population‐based congenital heart defect (CHD) epidemiology and outcomes. These individual databases are also relied upon for accurate coding of CHD to estimate population prevalence. Methods and Results This validation project assessed a sample of 774 cases from 4 surveillance sites to determine the positive predictive value (PPV) for identifying a true CHD case and classifying CHD anatomic group accurately based on 57 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes. Chi‐square tests assessed differences in PPV by CHD severity and age. Overall, PPV was 76.36% (591/774 [95% CI, 73.20–79.31]) for all sites and all CHD‐related ICD‐9‐CM codes. Of patients with a code for complex CHD, 89.85% (177/197 [95% CI, 84.76–93.69]) had CHD; corresponding PPV estimates were 86.73% (170/196 [95% CI, 81.17–91.15]) for shunt, 82.99% (161/194 [95% CI, 76.95–87.99]) for valve, and 44.39% (83/187 [95% CI, 84.76–93.69]) for “Other” CHD anatomic group ( X 2 =142.16, P <0.0001). ICD‐9‐CM codes had higher PPVs for having CHD in the 3 younger age groups compared with those >64 years of age, ( X 2 =4.23, P <0.0001). Conclusions While CHD ICD‐9‐CM codes had acceptable PPV (86.54%) (508/587 [95% CI, 83.51–89.20]) for identifying whether a patient has CHD when excluding patients with ICD‐9‐CM codes for “Other” CHD and code 745.5, further evaluation and algorithm development may help inform and improve accurate identification of CHD in data sets across the CHD ICD‐9‐CM code groups.

Background: Administrative data permits analysis of large cohorts but relies on International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD) codes that may not reflect true congenital heart defects (CHD). Methods: 1497 cases with at least one encounter between 1/1/2010 — 12/31/2019 in two healthcare systems (one adult, one pediatric) identified by at least one of 87 ICD CHD codes were validated through chart review for the presence of CHD and CHD anatomic group. Results: Inter- and intra-observer reliability averaged > 95%. Positive predictive value (PPV) of ICD codes for CHD was 68.1% (1020/1497) overall, 94.6% (123/130) for cases identified in both healthcare systems, 95.8% (249/260) for severe codes, 52.6% (370/703) for shunt codes, 75.9% (243/320) for valve codes, 73.5% (119/162) for shunt and valve codes, and 75.0% (39/52) for "Other CHD" (7 ICD codes). PPV for cases with >1 unique CHD code was 85.4% (503/589) vs. 56.3% (498/884) for one CHD code. Of cases with secundum atrial septal defect ICD codes 745.5/Q21.1 in isolation, 30.9% (123/398) had a confirmed CHD. Patent foramen ovale was present in 66.2% (316/477) of false positives (FP). The median number of unique CHD-coded encounters was higher for true positives (TP) than FP (2.0; interquartile range [IQR]: 1.0-3.0 vs 1.0; IQR:1.0-1.0, respectively, p<0.0001). TP had younger mean age at first encounter with a CHD code than FP (22.4 years vs 26.3 years, p=0.0017). Conclusion: PPV of CHD ICD codes varies by characteristics for detection of CHD by ICD code and anatomic grouping. While an ICD code for severe CHD and/or the presence of a case in more than one data source, regardless of anatomic group, is associated with higher PPV for CHD, most TP cases did not have these characteristics. The development of algorithms to improve accuracy may improve administrative data for CHD surveillance.

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