Specificity of International Classification of Diseases codes for bronchopulmonary dysplasia: an investigation using electronic health record data and a large insurance database

Beam, Kristyn S.; Lee, Matthew; Hirst, Keith; Beam, Andrew L.; Parad, Richard B.

doi:10.1038/s41372-021-00965-3

Cited by 16 publications

(11 citation statements)

References 30 publications

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“…There are several limitations that must be considered when evaluating this investigation. First, we recognize that Systemized Nomenclature of Medicine—Clinical Terms (SNOMED) coding as captured from the EHR does not always completely mimic or replicate clinical findings in patients ( 26 ). This is particularly true for categories such as diagnoses where clinical variability and interpretation can result in subjectivity.…”

Section: Discussionmentioning

confidence: 99%

Data-driven longitudinal characterization of neonatal health and morbidity

et al. 2023

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Although prematurity is the single largest cause of death in children under 5 years of age, the current definition of prematurity, based on gestational age, lacks the precision needed for guiding care decisions. Here, we propose a longitudinal risk assessment for adverse neonatal outcomes in newborns based on a deep learning model that uses electronic health records (EHRs) to predict a wide range of outcomes over a period starting shortly before conception and ending months after birth. By linking the EHRs of the Lucile Packard Children’s Hospital and the Stanford Healthcare Adult Hospital, we developed a cohort of 22,104 mother-newborn dyads delivered between 2014 and 2018. Maternal and newborn EHRs were extracted and used to train a multi-input multitask deep learning model, featuring a long short-term memory neural network, to predict 24 different neonatal outcomes. An additional cohort of 10,250 mother-newborn dyads delivered at the same Stanford Hospitals from 2019 to September 2020 was used to validate the model. Areas under the receiver operating characteristic curve at delivery exceeded 0.9 for 10 of the 24 neonatal outcomes considered and were between 0.8 and 0.9 for 7 additional outcomes. Moreover, comprehensive association analysis identified multiple known associations between various maternal and neonatal features and specific neonatal outcomes. This study used linked EHRs from more than 30,000 mother-newborn dyads and would serve as a resource for the investigation and prediction of neonatal outcomes. An interactive website is available for independent investigators to leverage this unique dataset: https://maternal-child-health-associations.shinyapps.io/shiny_app/ .

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Section: Discussionmentioning

confidence: 99%

Data-driven longitudinal characterization of neonatal health and morbidity

et al. 2023

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“…Use of administrative data has inherent limitations, particularly in classification of medical diagnoses as compared with medications or procedures . We chose a primary outcome defined by PH treatment administration instead of ICD billing codes based on a presumption that drug treatment billing would more accurately reflect clinically important PH.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Hypertension in Preterm Infants Treated With Laser vs Anti–Vascular Endothelial Growth Factor Therapy for Retinopathy of Prematurity

et al. 2022

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ImportanceAnti–vascular endothelial growth factor (VEGF) therapy for retinopathy of prematurity (ROP) has potential ocular and systemic advantages compared with laser, but we believe the systemic risks of anti-VEGF therapy in preterm infants are poorly quantified.ObjectiveTo determine whether there was an association with increased risk of pulmonary hypertension (PH) in preterm infants with ROP following treatment with anti-VEGF therapy as compared with laser treatment.Design, Setting, and ParticipantsThis multicenter retrospective cohort study took place at neonatal intensive care units of 48 children’s hospitals in the US in the Pediatric Health Information System database from 2010 to 2020. Participants included preterm infants with gestational age at birth 22 0/7 to 31 6/7 weeks who had ROP treated with anti-VEGF therapy or laser photocoagulation.ExposuresAnti-VEGF therapy vs laser photocoagulation.Main Outcomes and MeasuresNew receipt of pulmonary vasodilators at least 7 days after ROP therapy was compared between exposure groups, matched using propensity scores generated from preexposure variables, and adjusted for birth year and hospital. The odds of receiving an echocardiogram after 30 days of age was also included to adjust for secular trends and interhospital variation in PH screening.ResultsAmong 1577 patients (55.9% male) meeting inclusion criteria, 689 received laser photocoagulation and 888 received anti-VEGF treatment (95% bevacizumab, 5% ranibizumab). Patients were first treated for ROP at median 36.4 weeks’ postmenstrual age (IQR, 34.6-38.7). A total of 982 patients (491 in each group) were propensity score matched. Good covariate balance was achieved, as indicated by a model variance ratio of 1.15. More infants who received anti-VEGF therapy were treated for PH, but when adjusted for hospital and year, this was no longer statistically significant (6.7%; 95% CI, 2.6-6.9 vs 4.3% 95% CI, 4.4-10.2; adjusted odds ratio, 1.62; 95% CI, 0.90-2.89; P = .10).Conclusions and RelevanceAnti-VEGF therapy was not associated with greater use of pulmonary vasodilators after adjustment for hospital and year. Our findings suggest exposure to anti-VEGF may be associated with PH, although we cannot exclude the possibility of residual confounding based on systemic comorbidities or hospital variation in practice. Future studies investigating this possible adverse effect seem warranted.

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“…In addition, we used ICD 9/10 codes to identify our outcome measures and covariates, and these have varying specificity and sensitivity. 24 Also, from our data, it is not possible for us to determine why household members may be using these opioid medications; such information could help inform future interventions. Finally, we only observe overdoses that present to the health care system.…”

Section: Ta B L E 2 (Continued)mentioning

confidence: 99%

Association between household opioid prescriptions and risk for overdose among family members not prescribed opioids

Arakkal,

Polgreen,

Chapman

et al. 2023

Pharmacotherapy

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BackgroundPrescription opioids have contributed to the rise in opioid‐related overdoses and deaths. The presence of opioids within households may increase the risk of overdose among family members who were not prescribed an opioid themselves. Larger quantities of opioids may further increase risk.ObjectivesTo determine the risk of opioid overdose among individuals who were not prescribed an opioid but were exposed to opioids prescribed to other family members in the household, and evaluate the risk in relation to the total morphine milligram equivalents (MMEs) present in the household.MethodsWe conducted a cohort study using a large database of commercial insurance claims from 2001 to 2021. For inclusion in the cohort, we identified individuals not prescribed an opioid in the prior 90 days from households with two or more family members, and determined the total MMEs prescribed to other family members. Individuals were stratified into monthly enrollment strata defined by household opioid exposure and other confounders. A generalized linear model was used to estimate incidence rate ratios (IRRs) for overdose.ResultsOverall, the incidence of overdose among enrollees in households where a family member was prescribed an opioid was 1.73 (95% confidence interval [CI]: 1.67–1.78) times greater than households without opioid prescriptions. The risk of overdose increased continuously with the level of potential MMEs in the household from an IRR of 1.23 (95% CI: 1.16–1.32) for 1–100 MMEs to 4.67 (95% CI: 4.18–5.22) for >12,000 MMEs. The risk of overdose associated with household opioid exposure was greatest for ages 1–2 years (IRR: 3.46 [95% CI: 2.98–4.01]) and 3–5 years (IRR: 3.31 [95% CI: 2.75–3.99]).ConclusionsThe presence of opioids in a household significantly increases the risk of overdose among other family members who were not prescribed an opioid. Higher levels of MMEs, either in terms of opioid strength or quantity, were associated with increased levels of risk. Risk estimates may reflect accidental poisonings among younger family members.

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Specificity of International Classification of Diseases codes for bronchopulmonary dysplasia: an investigation using electronic health record data and a large insurance database

Cited by 16 publications

References 30 publications

Data-driven longitudinal characterization of neonatal health and morbidity

Data-driven longitudinal characterization of neonatal health and morbidity

Pulmonary Hypertension in Preterm Infants Treated With Laser vs Anti–Vascular Endothelial Growth Factor Therapy for Retinopathy of Prematurity

Association between household opioid prescriptions and risk for overdose among family members not prescribed opioids

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