Overcoming challenges of establishing a hospital-based out-of-hospital cardiac arrest registry: accuracy of case identification using administrative data and clinical registries.
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ABSTRACT: Introduction
Comprehensive identification of out-of-hospital cardiac arrest (OHCA) cases for inclusion in registries remains challenging due to the inherent diversity of OHCA aetiology, presentation, and management. The Northern Adelaide Local Health Network (NALHN) OHCA registry identifies OHCAs presenting to NALHN hospitals using existing data sources to monitor in-hospital treatment and survival. This study aimed to investigate the accuracy of hospital-based data sources for identifying OHCA cases treated at hospital.Methods
Retrospective analysis of all OHCAs aged >18 years included in the NALHN OHCA registry between 2011-16. Registry cases are identified from an emergency medical service (EMS) OHCA registry, Emergency Department (ED) and ICD-10 coding datasets, and key-word searches of two in-hospital clinical registries. Sensitivity and positive predictive values (PPV) of each hospital-based data source were analysed with respect to (a) the number of cases expected to be identified by that source, (b) total OHCA. Non-OHCAs yielded by each source were explored and a sub-analysis of ICD-10 codes was performed.Results
Between 2011-16, the four hospital-based sources yielded 992 cases, of which 383 were confirmed as OHCA. The ED coding dataset was the most accurate with a sensitivity and PPV of 78%. The ICD-10 coding dataset had good sensitivity but low PPV (33%). The ED coding dataset, combined with the two in-hospital clinical registries, identified 93% of OHCAs.Conclusions
No single dataset identified all OHCAs presenting to NALHN hospitals. Combined hospital-based data sources provide a valid method of identifying OHCAs treated at hospital that may be adapted to augment EMS-based data.
SUBMITTER: Wittwer MR
PROVIDER: S-EPMC8244476 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:OBJECTIVE:We adapted a composite neonatal adverse outcome indicator (NAOI), originally derived in Australia, and assessed its feasibility and validity as an outcome indicator in English administrative hospital data. DESIGN:We used Hospital Episode Statistics (HES) data containing information infants born in the English National Health Service (NHS) between 1 April 2014 and 31 March 2015. The Australian NAOI was mapped to diagnoses and procedure codes used within HES and modified to reflect data quality and neonatal health concerns in England. To investigate the concurrent validity of the English NAOI (E-NAOI), rates of NAOI components were compared with population-based studies. To investigate the predictive validity of the E-NAOI, rates of readmission and death in the first year of life were calculated for infants with and without E-NAOI components. RESULTS:The analysis included 484?007 (81%) of the 600?963 eligible babies born during the timeframe. 114/148 NHS trusts passed data quality checks and were included in the analysis. The modified E-NAOI included 23 components (16 diagnoses and 7 procedures). Among liveborn infants, 5.4% had at least one E-NAOI component recorded before discharge. Among newborns discharged alive, the E-NAOI was associated with a significantly higher risk of death (0.81%?vs 0.05%; p<0.001) and overnight hospital readmission (15.7%?vs 7.1%; p<0.001) in the first year of life. CONCLUSIONS:A composite NAOI can be derived from English hospital administrative data. This E-NAOI demonstrates good concurrent and predictive validity in the first year of life. It is a cost-effective way to monitor neonatal outcomes.
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Project description:IntroductionEarly recognition of out-of-hospital cardiac arrest (OHCA) by the medical dispatcher is a prerequisite for an effective chain of survival, leading to rapid dispatch of emergency medical services.AimTo analyse and compare the accuracy of the Emergency Medical Dispatch Centre in identifying OHCA before and after an educational intervention.MethodsA quality-assessment study collecting data from prehospital medical voice logs in Southern Denmark during two periods. Baseline data and post-interventional data were obtained during December, January, and February 2017/2018 and 2019/2020, respectively. We imposed an intervention consisting of a specifically targeted education in quick assessment of OHCA and instructions regarding telephone-assisted-CPR.The primary outcome measure was the dispatcher's ability to recognise OHCA. Secondary outcome measures were time from contact with the caller to the dispatcher formulated essential questions related to the NO-NO-GO algorithm. These questions included an assessment of the patients' consciousness and respiratory efforts and if both negative, would ideally lead to the dispatcher initiating telephone-assisted-CPR. All data was analysed in accordance with the recommendations and performance goals made by Resuscitation Academy.ResultsBaseline data included 209 calls. Post-interventional data was based on 208 calls.The sensitivity for recognition of OHCA was 82.3% (95% CI: 76.4-87.2%) before and 92.7% (95% CI: 88.2-95.8%) after the intervention (p = 0.0014). The median duration of calls before recognition of OHCA was 68 and 56 s before and after the intervention (p = 0.097).ConclusionAfter the period of intervention, the accuracy of OHCA recognition by dispatchers improved. The median time to identify OHCA or recognise the first compression did not differ significantly. This indicates that continuing education and quality assessment may be beneficial and necessary.
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