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Billing diagnoses do not accurately identify out-of-hospital cardiac arrest patients: An analysis of a regional healthcare system.

ABSTRACT: BACKGROUND:International Classification of Diseases 9th Edition's Clinical Modification (ICD-9CM) codes are frequently used in health services research. We tested the operating characteristics of ICD-9CM codes for identifying out-of-hospital cardiac arrest (OHCA) subjects. METHODS:We used ICD-9CM codes to generate an "administrative cohort" of subjects treated after possible OHCA at one of six emergency departments (EDs) between January 2010 and April 2014. We performed a structured chart review to determine proportion of this administrative cohort with actual OHCA (true positive rate for the ICD-9CM-based search method). The largest study site maintains a prospective registry of consecutive OHCA subjects, which we used to construct a "registry cohort". We used this cohort to calculate the sensitivity of the ICD-9CM-based search strategy at this site, and compared in-hospital mortality and discharge dispositions between the two cohorts using Chi-square tests. RESULTS:ICD-9CM codes identified 2461 subjects that comprised the administrative cohort. Of these, the true positive rate for actual OHCA on chart review was 40%. ICD9-CM code sensitivity was 100% for subjects coded as dead on arrival and 19% for subjects coded as surviving to ED disposition. There were 609 OHCA subjects in the registry cohort and 268 subjects in the administrative cohort who presented to registry site. Only 26 subjects appeared in both cohorts. In-hospital mortality was significantly higher in the administrative cohort than the registry cohort (91% vs. 61%, p<0.001), and hospital discharge disposition of survivors was less favorable (p<0.001). Neither difference persisted after excluding subjects surviving <6h. CONCLUSION:Compared to a prospective registry, ICD-9CM codes are an insensitive method to identify OHCA subjects. Moreover, ICD-9CM codes identify a biased sample of the OHCA population with higher mortality.

SUBMITTER: Coppler PJ

PROVIDER: S-EPMC4715911 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Billing diagnoses do not accurately identify out-of-hospital cardiac arrest patients: An analysis of a regional healthcare system.

Coppler Patrick J PJ Rittenberger Jon C JC Wallace David J DJ Callaway Clifton W CW Elmer Jonathan J

Resuscitation 20151021

<h4>Background</h4>International Classification of Diseases 9th Edition's Clinical Modification (ICD-9CM) codes are frequently used in health services research. We tested the operating characteristics of ICD-9CM codes for identifying out-of-hospital cardiac arrest (OHCA) subjects.<h4>Methods</h4>We used ICD-9CM codes to generate an "administrative cohort" of subjects treated after possible OHCA at one of six emergency departments (EDs) between January 2010 and April 2014. We performed a structur ...[more]

PMID: 26476197

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Project description:BackgroundCerebral hypoperfusion may aggravate neurological damage after cardiac arrest. Near-infrared spectroscopy (NIRS) provides information on cerebral oxygenation but its relevance during post-resuscitation care is undefined. We investigated whether cerebral oxygen saturation (rSO2) measured with NIRS correlates with the serum concentration of neuron-specific enolase (NSE), a marker of neurological injury, and with clinical outcome in out-of-hospital cardiac arrest (OHCA) patients.MethodsWe performed a post hoc analysis of a randomised clinical trial (COMACARE, NCT02698917) comparing two different levels of carbon dioxide, oxygen and arterial pressure after resuscitation from OHCA with ventricular fibrillation as the initial rhythm. We measured rSO2 in 118 OHCA patients with NIRS during the first 36 h of intensive care. We determined the NSE concentrations from serum samples at 48 h after cardiac arrest and assessed neurological outcome with the Cerebral Performance Category (CPC) scale at 6 months. We evaluated the association between rSO2 and serum NSE concentrations and the association between rSO2 and good (CPC 1-2) and poor (CPC 3-5) neurological outcome.ResultsThe median (inter-quartile range (IQR)) NSE concentration at 48 h was 17.5 (13.4-25.0) μg/l in patients with good neurological outcome and 35.2 (22.6-95.8) μg/l in those with poor outcome, p < 0.001. We found no significant correlation between median rSO2 and NSE at 48 h, rs = - 0.08, p = 0.392. The median (IQR) rSO2 during the first 36 h of intensive care was 70.0% (63.5-77.0%) in patients with good outcome and 71.8% (63.3-74.0%) in patients with poor outcome, p = 0.943. There was no significant association between rSO2 over time and neurological outcome. In a binary logistic regression model, rSO2 was not a statistically significant predictor of good neurological outcome (odds ratio 0.99, 95% confidence interval 0.94-1.04, p = 0.635).ConclusionsWe found no association between cerebral oxygenation measured with NIRS and NSE concentrations or outcome in patients resuscitated from OHCA.Trial registrationClinicalTrials.gov, NCT02698917 . Registered on 26 January 2016.

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Billing diagnoses do not accurately identify out-of-hospital cardiac arrest patients: An analysis of a regional healthcare system.

Publications

Billing diagnoses do not accurately identify out-of-hospital cardiac arrest patients: An analysis of a regional healthcare system.

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