Overcoming challenges of establishing a hospital-based out-of-hospital cardiac arrest registry: accuracy of case identification using administrative data and clinical registries

Wittwer, M.; Ruknuddeen, Mohammed Ishaq; Thorrowgood, Mel; Zeitz, Chris; Beltrame, John F.; Arstall, Margaret A.

doi:10.1016/j.resplu.2021.100136

Cited by 12 publications

(7 citation statements)

References 24 publications

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“… 18 Nevertheless, validation studies on OHCA case definitions using ICD codes are scarce in other countries. 19 …”

Section: Discussionmentioning

confidence: 99%

Validation of ICD-9-CM and ICD-10-CM Diagnostic Codes for Identifying Patients with Out-of-Hospital Cardiac Arrest in a National Health Insurance Claims Database

Tsai¹,

Tsai²,

Pan³

et al. 2022

CLEP

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Purpose Taiwan’s national health insurance (NHI) database is a valuable resource for large-scale epidemiological and long-term survival research for out-of-hospital cardiac arrest (OHCA). We developed and validated case definition algorithms for OHCA based on the International Classification of Diseases (ICD) diagnostic codes and billing codes for NHI reimbursement. Patients and Methods Claims data and medical records of all emergency department visits from 2010 to 2020 were retrieved from the hospital’s research-based database. Death-related diagnostic codes and keywords were used to identify potential OHCA cases, which were ascertained by chart reviews. We tested the performance of the developed OHCA algorithms and validated them on an external dataset. Results The algorithm defining OHCA as any cardiac arrest (CA)-related ICD code in the first three diagnosis fields performed the best with a sensitivity of 89.5% (95% confidence interval [CI], 88.2–90.7%), a positive predictive value (PPV) of 90.6% (95% CI, 89.4–91.8%), and a kappa value of 0.900 (95% CI, 0.891–0.909). The second-best algorithm consists of any CA-related ICD code in any diagnosis field with a billing code for triage acuity level 1, achieving a sensitivity of 85.6% (95% CI, 84.1–87.0%), a PPV of 93.6% (95% CI, 92.5–94.5), and a kappa value of 0.894 (95% CI, 0.884–0.903). Both algorithms performed well in external validation. In subgroup analyses, the former algorithm performed the best in adult patients, outpatient claims, and during the ICD-9 era. The latter algorithm performed the best in the inpatient claims and during the ICD-10 era. The best algorithm for identifying pediatric OHCAs was any CA-related ICD code in the first three diagnosis fields with a billing code for triage acuity level 1. Conclusion Our results may serve as a reference for future OHCA studies using the Taiwan NHI database.

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“… 18 Nevertheless, validation studies on OHCA case definitions using ICD codes are scarce in other countries. 19 …”

Section: Discussionmentioning

confidence: 99%

Validation of ICD-9-CM and ICD-10-CM Diagnostic Codes for Identifying Patients with Out-of-Hospital Cardiac Arrest in a National Health Insurance Claims Database

Tsai¹,

Tsai²,

Pan³

et al. 2022

CLEP

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“…Identification of predictors of noninformative coding has not previously been reported in the literature. All similar studies to date 11‐13,18,19 have primarily interrogated the question of what proportion of cases are accurately identified or informative, but without detail on predictive factors for which patients receive inaccurate or incomplete diagnoses. Our finding in Australia that 60% of cardiac arrest discharge diagnoses in the age group 1 to 50 years are noninformative, with detailed reasons and predictors identified, may be useful to assist discharge diagnosis training amongst medical and administrative staff.…”

Section: Discussionmentioning

confidence: 99%

Inconsistent discharge diagnoses for young cardiac arrest episodes: insights from a statewide registry

Paratz

Heusden

Ball

et al. 2022

Internal Medicine Journal

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BackgroundAdministrative coding of out‐of‐hospital cardiac arrest (OHCA) is heterogeneous, with the prevalence of noninformative diagnoses uncertain.AimTo characterize the prevalence and type of non‐informative diagnoses in a young cardiac arrest population.MethodsHospital discharge diagnoses provided to a statewide OHCA registry were characterised as either ‘informative’ or ‘noninformative.’ Informative diagnoses stated an OHCA had occurred or defined OHCA as occurring due to coronary artery disease, cardiomyopathy, channelopathy, definite noncardiac cause, or no known cause. Noninformative diagnoses were blank, stated presenting cardiac rhythm only, provided irrelevant information or presented a complication of the OHCA as the main diagnosis. Characteristics of patients receiving informative versus noninformative diagnoses were compared.ResultsOf 1479 patients with OHCA aged 1 to 50 years, 290 patients were admitted to 15 hospitals. Ninety diagnoses (31.0%) were noninformative (arrest rhythm = 50, blank = 21, complication = 10 and irrelevant = 9). Two hundred diagnoses (69.0%) were informative (cardiac arrest = 84, coronary artery disease = 54, noncardiac diagnosis = 48, cardiomyopathy = 8, arrhythmia disorder = 4 and unascertained = 2). Only 10 diagnoses (3.5%) included both OHCA and an underlying cause. Patients receiving a noninformative diagnosis were more likely to have survived OHCA or been referred for forensic assessment (P = 0.011) and had longer median length of stay (9 vs 5 days, P = 0.0019).ConclusionAlmost one third of diagnoses for young patients discharged after an OHCA included neither OHCA nor any underlying cause. Underestimating the burden of OHCA impacts ongoing patient and at‐risk family care, data sampling strategies, international statistics and research funding.

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“…The Northern Adelaide Local Health Network (NALHN) OHCA registry is a hospital-based quality assurance initiative (24). Variables are obtained from linkage with existing clinical registries and abstraction from the hospital medical record.…”

Section: Data Sources and Definitionsmentioning

confidence: 99%

“…Crude and age-adjusted incidence calculations were made using enumerated population data that was averaged between 2011 and 2016 to account for dynamic population changes and may not accurately reflect the true at-risk population. OHCA incidence calculations may be underestimated due to missing cases within SAAS-CAR during the study period (24). Arrest location and EMS response times are important predictors of survival that may have influenced outcome but were not available within SAAS-CAR during the study period.…”

Section: Limitationsmentioning

confidence: 99%

Sex Differences in Incidence and Outcome of Out-of-Hospital Cardiac Arrest Within a Local Health Network

Wittwer

Aldridge

Hein

et al. 2022

Front. Cardiovasc. Med.

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IntroductionSex and gender differences in presentation and characteristics of out-of-hospital cardiac arrest (OHCA) are established in cohorts with presumed cardiac aetiology but not non-cardiac etiology. This study investigated the effect of sex on incidence and outcome of OHCA according to presumed and adjudicated aetiology within a local health network.MethodsPopulation-based observational cohort study of emergency medical services (EMS) attended OHCAs within an Australian local health network. Cases identified from an EMS registry between 2012-2016 were linked to a hospital registry. Age-standardised incidence and baseline characteristics were stratified by sex for EMS-treated OHCA, non-EMS witnessed presumed cardiac and obvious non-cardiac sub-cohorts, and hospitalised cases. Logistic regression was used to explore the primary outcome of survival to hospital discharge.ResultsWe identified 2,024 EMS-attended and 780 EMS-treated OHCAs. The non-EMS witnessed sub-cohorts comprised 504 presumed cardiac and 168 obvious non-cardiac OHCAs. Adjudicated aetiology was recorded in 123 hospitalised cases. Age-standardised incidence for women was almost half that of men across all groups. Across cohorts, women were generally older and arrested with a non-shockable initial rhythm in an area of low socioeconomic status. There was no sex difference in the primary outcome for the main EMS-treated cohort or in the non-cardiac sub-cohorts. The sex difference in outcome in the presumed cardiac sub-cohort was not present after multivariable adjustment.ConclusionsThere are sex differences in incidence and outcome of EMS-treated OHCA that appear to be driven by differences in susceptibility to cardiac arrhythmias and underlying etiology, rather than treatment delays or disparities.

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Overcoming challenges of establishing a hospital-based out-of-hospital cardiac arrest registry: accuracy of case identification using administrative data and clinical registries

Cited by 12 publications

References 24 publications

Validation of ICD-9-CM and ICD-10-CM Diagnostic Codes for Identifying Patients with Out-of-Hospital Cardiac Arrest in a National Health Insurance Claims Database

Validation of ICD-9-CM and ICD-10-CM Diagnostic Codes for Identifying Patients with Out-of-Hospital Cardiac Arrest in a National Health Insurance Claims Database

Inconsistent discharge diagnoses for young cardiac arrest episodes: insights from a statewide registry

Sex Differences in Incidence and Outcome of Out-of-Hospital Cardiac Arrest Within a Local Health Network

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