Validity of Administrative Database Coding for Kidney Disease: A Systematic Review

Vlasschaert, Meghan; Bejaimal, Shayna A.D.; Hackam, Daniel G.; Quinn, Robert R.; Cuerden, Meaghan; Oliver, Matthew J.; Iansavichus, Arthur V.; Sultan, Nabil; Mills, Alison; Garg, Amit X.

doi:10.1053/j.ajkd.2010.08.031

Cited by 175 publications

(166 citation statements)

References 43 publications

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“…18 We excluded patients with acute renal failure from the ESRD group and the ICD-9 code of AKI has a specificity of 90%. 19 The sensitivity and specificity of CPR code is variable across hospitals but has been consistently used in the literature.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of In-Hospital Cardiopulmonary Resuscitation in Maintenance Dialysis Patients

Saeed

Adil

Malik

et al. 2015

Journal of the American Society of Nephrology

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Outcomes of cardiopulmonary resuscitation (CPR) in hospitalized patients with ESRD requiring maintenance dialysis are unknown. Outcomes of in-hospital CPR in these patients were compared with outcomes in the general population using data from the Nationwide Inpatient Sample (NIS;2005. The study population included all adults ($18years old) from the general population and those with a history of ESRD. Baseline characteristics, in-hospital complications, and discharge outcomes were compared between the two groups. The effects of in-hospital CPR on mortality, length of stay, hospitalization charges, and discharge destination were analyzed. Yearly national trends in survival, discharge to home, and length of stay were also examined using the Cochran-Armitage trend test. During the study period, 56,069 patients with ESRD underwent in-hospital CPR compared with 323,620 patients from the general population. Unadjusted in-hospital mortality rates were higher in patients with ESRD (73.9% versus 71.8%, P,0.001) on univariate analysis. After adjusting for age, gender, and potential confounders, patients with ESRD had higher odds of mortality (odds ratio, 1.24; 95% confidence interval, 1.11 to 1.3; P,0.001). Survival after CPR improved in the year 2011 compared with 2005 (31% versus 21%, P,0.001). Multivariate analysis also revealed that a greater proportion of patients with ESRD who survived were discharged to skilled nursing facilities. In conclusion, outcomes after in-hospital CPR are improving in patients with ESRD but remain worse than outcomes in the general population. Patients with ESRD who survive are more likely to be discharged to nursing homes. 26: 3093-3101, 201526: 3093-3101, . doi: 10.1681 Ventricular arrhythmias and sudden and cardiac death necessitating cardiopulmonary resuscitation (CPR) are common occurrences in patients on maintenance dialysis. 1,2 Such events mostly occur during dialysis and only 56% of these patients present to the hospital alive, with 24% of those surviving to the hospital discharge and 15% alive at least 1year after the event. 1 However, few data are available on the outcomes of CPR in hospitalized patients with ESRD. The existing literature consists of small and older studies that do not reflect current standards of CPR practices. In a study of 74 patients with ESRD undergoing CPR in both hospital and dialysis units, 37% survived the initial resuscitation; 6% were alive at the time of hospital discharge, and 3% were still living 6 months later. 3 Patients without ESRD had similar immediate (27%) survival and survival to hospital discharge was not significantly better (6% in patients on dialysis and 30% in patients without ESRD). However, post-CPR survival at 6 months was significantly better in patients without ESRD (2% in patients on dialysis versus 23% in patients without ESRD, J Am Soc Nephrol

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Section: Discussionmentioning

confidence: 99%

Outcomes of In-Hospital Cardiopulmonary Resuscitation in Maintenance Dialysis Patients

Saeed

Adil

Malik

et al. 2015

Journal of the American Society of Nephrology

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“…AKI sensitivities were considered poor, with a median of 21%. 31 The ICD-9 codes used in our study did not match any of the sets used in the aforementioned studies, which were all performed in adults, making direct comparison diffi cult. Nonetheless, our results are consistent with previous analyses.…”

Section: Discussionmentioning

confidence: 99%

Administrative Data Misclassifies and Fails to Identify Nephrotoxin-Associated Acute Kidney Injury in Hospitalized Children

Schaffzin¹,

Dodd

Nguyen

et al. 2014

Hospital Pediatrics

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Objectives: Nephrotoxin exposure is a common cause of acute kidney injury (AKI) in hospitalized children. AKI detection relies on regular serum creatinine (SCr) screening among exposed patients. We sought to determine how well administrative data identify hospitalized noncritically ill children with nephrotoxic medication-associated AKI in the contexts of incomplete and complete screening. Methods: We conducted a single-center retrospective cohort study among noncritically ill hospitalized children. We compared administrative data sensitivity to that among a separate cohort for whom adequate screening was defined as daily SCr measurement. For the original cohort, nephrotoxin exposure was defined as exposure to ≥3 nephrotoxins at once or ≥3 days of aminoglycoside therapy. AKI was defined by the change in SCr (pediatric-modified Risk Injury Failure Loss End-Stage Renal Disease [pRIFLE] criteria) or discharge code. Adequate SCr screening was defined as 2 measurements obtained ≤96 hours apart. Administrative data and laboratory values were merged to compare AKI by discharge code and pRIFLE criteria. Results: 747 of 1472 (50.7%) nephrotoxin-exposed patients were adequately screened; 82 (11.0%) had AKI by pRIFLE criteria, 52 (7.0%) by discharge code. Sensitivity of nephrotoxin-associated AKI diagnosis by discharge code compared with pRIFLE criteria was 23.2% (95% confidence interval = 14.0–32.3). In the comparison cohort, 70 (26.8%) patients had AKI by pRIFLE criteria and 26 (10.0%) by discharge code; sensitivity was 21.4% (95% confidence interval = 11.8%–31.0%). Conclusions: pRIFLE criteria identified more patients than were identified by discharge code. Identifying patients with nephrotoxin-associated AKI by discharge code, even in the presence of complete AKI detection, underrepresents the true incidence of nephrotoxin-associated AKI in hospitalized children.

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“…Similarly, given the limitations of diagnostic codes for acute kidney injury, we did not examine the outcome of perioperative acute kidney injury that was not treated with dialysis. 16 We were thus unable to contrast the outcomes over time of similar patients who did and did not receive acute dialysis. Finally, secular changes in database codes and coding practices may have influenced some of our results; however, most codes were stable during our period of interest and were unlikely to affect the overall trends we saw.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…6,[12][13][14] Most multicentre studies were conducted in the nonsurgical setting and used diagnostic codes for acute kidney injury not requiring dialysis; however, these codes can be inaccurate. 15,16 In contrast, a procedure such as dia lysis is easily determined. The incidence of acute dia lysis after elective surgery is of particular interest given the need for surgical consent, the severe nature of the event and the potential for mitigation.…”

mentioning

confidence: 99%

Secular trends in acute dialysis after elective major surgery — 1995 to 2009

Siddiqui

Coca

Devereaux

et al. 2012

CMAJ

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119

116

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Research CMAJBackground: Acute kidney injury is a serious complication of elective major surgery. Acute dialysis is used to support life in the most severe cases. We examined whether rates and outcomes of acute dialysis after elective major surgery have changed over time. Methods:We used data from Ontario's universal health care databases to study all consecutive patients who had elective major surgery at 118 hospitals between 1995 and 2009. Our primary outcomes were acute dialysis within 14 days of surgery, death within 90 days of surgery and chronic dialysis for patients who did not recover kidney function.Results: A total of 552 672 patients underwent elective major surgery during the study period, 2231 of whom received acute dialysis. The incidence of acute dialysis increased steadily from 0.2% in 1995 (95% confidence interval [CI] 0.15-0.2) to 0.6% in 2009 (95% CI 0.6-0.7). This increase was primarily in cardiac and vascular surgeries. Among patients who received acute dialysis, 937 died within 90 days of surgery (42.0%, 95% CI 40.0-44.1), with no change in 90-day survival over time. Among the 1294 patients who received acute dialysis and survived beyond 90 days, 352 required chronic dialysis (27.2%, 95% CI 24.8-29.7), with no change over time.Interpretation: The use of acute dialysis after cardiac and vascular surgery has increased substantially since 1995. Studies focusing on interventions to better prevent and treat perioperative acute kidney injury are needed. Abstract

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Validity of Administrative Database Coding for Kidney Disease: A Systematic Review

Cited by 175 publications

References 43 publications

Outcomes of In-Hospital Cardiopulmonary Resuscitation in Maintenance Dialysis Patients

Outcomes of In-Hospital Cardiopulmonary Resuscitation in Maintenance Dialysis Patients

Administrative Data Misclassifies and Fails to Identify Nephrotoxin-Associated Acute Kidney Injury in Hospitalized Children

Secular trends in acute dialysis after elective major surgery — 1995 to 2009

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