The Positive Predictive Value of Hospital Discharge Data for Identifying Severe Maternal Morbidity With and Without Blood Transfusion

Fabricant, Sonya P.; Opara, Karen N.; PAUL, Julianna V; Blissett, Gabriella; Rau, Alesandra R.; White, Jessica D.; Girma, Alodia; Sriprasert, Intira; Korst, Lisa M.; Mitchell, Evelyn

doi:10.1016/j.jcjq.2023.05.004

Cited by 2 publications

(4 citation statements)

References 13 publications

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“…Blood transfusions are estimated to account for over half of the severe maternal morbidity cases identified using the CDC criteria, 5 and prior studies have demonstrated poor PPV for the blood transfusion indicator. 8,9 Similarly, we found that eliminating transfusion-only cases of severe maternal morbidity from the CDC definition resulted in fewer false positives and a corresponding increase in PPV. For gold standard cases, restricting to non-transfusion cases eliminated only three deliveries, suggesting that most patients experienced severe maternal morbidity related to other causes.…”

Section: Discussionmentioning

confidence: 53%

“…The PPV for ICD-10 codes in our sample was low (28%), compared with 40%-48% in prior studies of ICD-9/10 codes in US populations. 5,8,9 This was the case even though the incidence of severe maternal morbidity in our study population (~7%) for both the ICD-10 and medical record definitions was higher than the national rate (~2%). 2 Our results also suggest that misclassification may differ by race and ethnicity; however, sample size limited our ability to fully explore variations by demographic and clinical factors.…”

Section: Discussionmentioning

confidence: 60%

“…Findings from one study using screen-positive sampling indicate a PPV of 40% for ICD-10 codes. 9 Notably, two studies reported a decline in the incidence of severe maternal morbidity in the United States following the ICD-9 to ICD-10 transition, 10,11 one study identified an increase, 12 and one study found no change. 13 Accurate measurement of severe maternal morbidity is essential for monitoring disease burden, identifying effective interventions, and addressing health inequities.…”

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confidence: 99%

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confidence: 99%

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Validation of ICD-10 Codes for Severe Maternal Morbidity at Delivery in a Public Hospital

Boulet,

Stanhope,

Valdez-Sinon

et al. 2024

Epidemiology

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Background: Severe maternal morbidity is a composite measure of serious obstetric complications that is often identified in administrative data using International Classification of Diseases (ICD) diagnosis and procedure codes for a set of 21 indicators. Prior studies of screen-positive cases have demonstrated low predictive value for ICD codes relative to the medical record. To our knowledge, the validity of ICD-10 codes for identifying severe maternal morbidity has not been fully described. Methods: We estimated the sensitivity, specificity, positive predictive value, and negative predictive value of ICD-10 codes for severe maternal morbidity occurring at delivery, compared with medical record abstraction (gold standard), for 1,000 deliveries that took place during 2016-2018 at a large, public hospital. Results: We identified a total of 67 cases of severe maternal morbidity using the ICD-10 definition, and 74 cases in the medical record. The sensitivity was 26% (95% confidence interval (CI): 16%, 37%), the positive predictive value was 28% (95% CI: 18%, 41%), the specificity was 95% (95% CI: 93%, 96%), and the negative predictive value was 94% (95% CI: 92%, 96%). Conclusions: The validity of ICD-10 codes for severe maternal morbidity in our high-burden population was poor, suggesting considerable potential for bias.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 60%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Validation of ICD-10 Codes for Severe Maternal Morbidity at Delivery in a Public Hospital

Boulet,

Stanhope,

Valdez-Sinon

et al. 2024

Epidemiology

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Postpartum Tubal Sterilization in Sickle Cell Disease in the 2012-2019 National Inpatient Sample

Luo,

Gemmill,

Scott

et al. 2024

Preprint

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Importance: Sickle cell disease (SCD) is associated with high-risk pregnancy and low rates of hormonal contraception use. Intersectional vulnerabilities among individuals with SCD in the United States (US) raise historically and socially contingent questions about tubal sterilization in individuals with SCD. However immediate postpartum tubal sterilization (TS) rates among individuals with SCD in the US are unknown. Objective: To compare rates of TS in deliveries to people with SCD and without SCD, and to determine the modifying effect of severe maternal morbidity (SMM) on the odds of TS. Design, Setting, and Participants: This repeated cross-sectional study used the 2012-2019 National Inpatient Sample to estimate the rate of TS among delivery hospitalizations to people with SCD, without SCD (non-SCD), Black people with and without SCD, and people with cystic fibrosis (CF). Logistic regression models estimated the odds of TS between SCD and non-SCD deliveries, SCD and non-SCD deliveries with Black race, and SCD and CF deliveries. We examined whether SMM modified the association between TS and SCD in interaction analyses. Exposure: SCD, CF Results: Among 29,822,518 deliveries, 6.7% underwent TS. Among 18,860 SCD deliveries, 8.8% underwent TS. Among 2,945 CF deliveries, 6.6% underwent TS. After adjusting for patient and hospital characteristics, SCD had higher odds of TS compared to non-SCD deliveries (aOR= 1.38 [1.06,1.79]) and in a stratified analysis of deliveries coded with Black race (aOR= 1.42 [1.06,1.90]). After adjusting for patient and hospital characteristics, there was no difference in the odds of TS between SCD or CF deliveries (aOR=1.0 [0.51,2.24]). SMM more than doubled the odds of TS in SCD deliveries (interaction: aOR=2.34 [1.57,3.47]; aOR= 2.14 [1.40,3.24] in deliveries coded with Black race). Conclusion: Even after accounting for patient and hospital characteristics, people with SCD have higher odds of immediate postpartum TS compared to control groups. SMM at delivery increased the odds of TS in SCD compared to all non-SCD deliveries and compared to CF deliveries. Possibly SMM severity, patient preference, or clinician recommendations inform this finding. SMM is 3-7 times more common in SCD than non-SCD pregnancies and may be a modifiable risk factor for TS in SCD deliveries.

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The Positive Predictive Value of Hospital Discharge Data for Identifying Severe Maternal Morbidity With and Without Blood Transfusion

Cited by 2 publications

References 13 publications

Validation of ICD-10 Codes for Severe Maternal Morbidity at Delivery in a Public Hospital

Validation of ICD-10 Codes for Severe Maternal Morbidity at Delivery in a Public Hospital

Postpartum Tubal Sterilization in Sickle Cell Disease in the 2012-2019 National Inpatient Sample

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