Improving accuracy of International Classification of Diseases codes for venous thromboembolism in administrative data

Sanfilippo, Kristen M.; Wang, Tzu‐Fei; Gage, Brian F.; Liu, Weijian; Carson, Kenneth R.

doi:10.1016/j.thromres.2015.01.012

Cited by 79 publications

(87 citation statements)

References 17 publications

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“…Time during chemotherapy administration was defined as PBM record of the first dose of chemotherapy prescription until plus 30 days past the last dose of chemotherapy. We identified VTE, defined as deep vein thrombosis (DVT), pulmonary embolism (PE), or both DVT and PE, by using a validated algorithm that requires an ICD-9 diagnostic code for VTE plus either anticoagulant therapy, common procedural terminology (CPT) code for placement of a vena-cava filter, or death within 30 days of ICD-9 diagnosis of VTE[19]. History of VTE could occur at any time before NHL diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Incidence of venous thromboembolism in patients with non-Hodgkin lymphoma

Sanfilippo

Wang

Gage

et al. 2016

Thrombosis Research

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Introduction Patients with non-Hodgkin lymphoma (NHL) have an increased risk of venous thromboembolism (VTE). Current risk-prediction models classify NHL as a single entity. We aimed to quantify the difference in VTE risk in follicular lymphoma (FL) versus diffuse large B cell lymphoma (DLBCL). Methods Using a prospective cohort study, we identified 2,730 patients (2,037 DLBCL; 693 FL) within the Veteran’s Administration Central Cancer Registry. A competing risk model assessed the association between VTE risk and histology in the first year after NHL diagnosis. We assessed the effect of additional risk factors for VTE in NHL. Results In univariate analysis, DLBCL was associated with increased risk of VTE compared to FL in the first year after diagnosis; this association was no longer significant in adjusted analysis (adjusted hazard ratio (aHR) 1.52; 95% CI 0.97–2.40). Major risk factors for VTE included history of VTE before NHL diagnosis (aHR 4.73, p=<0.0001) and time period during chemotherapy administration (aHR 7.60, p=<0.0001). Additional risk factors included: stage III/IV disease (p=0.02), BMI ≥ 30 (p=0.02), B-symptoms (p=0.02), and doxorubicin (p=0.04). The cumulative incidence of VTE was highest in the period following diagnosis and decreased over time for both histologies. Conclusion DLBCL is associated with increased risk of VTE compared to FL. This risk is markedly attenuated when adjusting for additional risk factors. The strongest predictors for development of VTE included: time period during chemotherapy administration (especially doxorubicin) and history of VTE. This knowledge can assist clinicians in identifying NHL patients at high risk for VTE.

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Section: Methodsmentioning

confidence: 99%

Incidence of venous thromboembolism in patients with non-Hodgkin lymphoma

Sanfilippo

Wang

Gage

et al. 2016

Thrombosis Research

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“…The limitations of using national administrative data for diagnosis and treatment data of VTE and PE have been well documented 19,20 and include accuracy of diagnosis coding as well as the lack of disease or procedure specific data. Other limitations of our study, such as missing data regarding time from admission to IVCF placement, though limited, may introduce selection bias.…”

Section: Discussionmentioning

confidence: 99%

Impact of Inferior Vena Cava Filter Placement on Short-Term Outcomes in Patients with Acute Pulmonary Embolism

Liang

Genovese

Avgerinos

et al. 2017

Annals of Vascular Surgery

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Background Inferior vena cava filters (IVCF) have been associated with improved survival in patients with acute pulmonary embolism (PE) in some studies. However, without randomization, those with early mortality who did not receive an IVCF may have died prior to treatment decision about filter placement, falsely contributing a survival advantage to those receiving IVCF and biasing the results of previous observational studies. The objective of this study is to evaluate the impact of IVCF on in-hospital mortality after adjusting for this survivor treatment selection. Methods National Inpatient Sample datasets from 2009–2012 were analyzed to assess the impact of IVCF placement on in-hospital mortality in all patients with acute PE. Subgroup analyses were performed in those with high-risk PE (hemodynamic shock) and also for those with both shock and concomitant thrombolysis. Inverse-propensity-score-weighting was used to balance clinical and comorbid differences between filter and non-filter groups. To account for survivor treatment selection bias, an extended Cox model was fitted with IVCF placement as a time-dependent covariate. Results We identified 263,955 patients with acute PE over this period; 36,702 (13.9%) received IVCF. Those receiving IVCF in the unadjusted cohort were older (IVCF: 66.3±15.9 vs. non-IVCF:62.4±17.4;p<0.001) with higher rates of shock (6.8% vs. 3.8%;p<0.001), deep venous thrombosis (32.8% vs. 13.9%;p<0.001), thrombolytic therapy (5.9% vs. 1.6%;p<0.001), and lower crude mortality (6.0% vs. 6.7%;p<0.001). Propensity-weighted extended Cox analysis showed that IVCF placement did not significantly decrease mortality hazard compared to an untreated patient (HR 0.93, 95% CI[0.89–1.01]). Similar results were seen in the combined high-risk and thrombolysis (HR 0.85, 95% CI[0.60–1.21]) subgroup and associated with worse outcomes in the high-risk (HR 1.2, 95% CI[1.11–1.38]) subgroup. Conclusions Placement of IVCF in all patients with acute PE, in high-risk patients, or in high-risk patients concurrently treated with thrombolysis is not significantly associated with improvement of in-hospital mortality when accounting for survivor treatment selection bias.

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“…23 Although treatment codes have been shown to increase the positive predictive value of a case definition, the use of the CPT coding system reduces the generalizability to use this validated CRS case definition in other countries. 24 For example, procedural coding in Canada adheres to the Canadian Classification of Health Interventions, and, in Australia, the Australian Classification of Health Interventions is used. Therefore, for cross-border applicability of a validated CRS case definition, a more universal ICD-based algorithm should be generated.…”

Section: Discussionmentioning

confidence: 99%

Case Definitions for Chronic Rhinosinusitis in Administrative Data: A Systematic Review

Lui

Rudmik

2015

Am J Rhinol�Allergy

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To optimize the accuracy of pharmacoepidemiologic research for CRS that used administrative data, it is important to apply appropriate case definitions for CRS. Various nonvalidated CRS case definitions are currently being used in administrative data base research. There is a need to develop a generalizable and validated ICD-based CRS case definition to increase the accuracy of future pharmacoepidemiologic research.

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Improving accuracy of International Classification of Diseases codes for venous thromboembolism in administrative data

Cited by 79 publications

References 17 publications

Incidence of venous thromboembolism in patients with non-Hodgkin lymphoma

Incidence of venous thromboembolism in patients with non-Hodgkin lymphoma

Impact of Inferior Vena Cava Filter Placement on Short-Term Outcomes in Patients with Acute Pulmonary Embolism

Case Definitions for Chronic Rhinosinusitis in Administrative Data: A Systematic Review

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