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Validation of Diagnostic Codes to Identify Carbon Monoxide Poisoning in Taiwan's Claims Data.

ABSTRACT: Purpose: Previous studies identified the study cohort or outcome of carbon monoxide poisoning (COP) by using the relevant disease diagnosis codes in secondary databases, but the validity of diagnosis codes of COP is unclear in such secondary databases. This study aimed to evaluate the accuracy of case definitions for COP using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes in Taiwan's health insurance claims data. Methods: We selected a 10% simple random sample from an original cohort of patients newly undergoing carboxyhemoglobin (COHb) testing under any clinical diagnosis at four Chang Gung Memorial Hospitals in Taiwan during 2011-2020. Two clinical doctors independently ascertained the COP diagnosis by reviewing the medical records as the reference standard. We estimated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of various case definitions (e.g., ICD-9-CM code, ICD-10-CM code and the uses of hyperbaric oxygen therapy) in the claims data. Results: We randomly selected 557 cases from the original cohort of 5,571 cases newly receiving COHb test in the study hospitals. We found 90, 35, and 9 cases were true-positive, false-positive, and false-negative episodes of COP, respectively, among 278 cases with an ICD-9-CM code of 986. A further 111, 34, and 6 cases were true-positive, false-positive, and false-negative episodes of COP, respectively, among 279 cases with an ICD-10-CM code of T58. Using ICD-9-CM codes, the sensitivity, specificity, PPV and NPV for COP were 90.9, 80.4, 72, and 94.1%, respectively. Using ICD-10-CM codes they were 94.9, 79, 76.6, and 95.5%, respectively. PPV typically increased when COP was the primary diagnosis and could reach 100% if patients with ICD-CM code 986 or T58 also received hyperbaric oxygen therapy during hospitalization. Conclusion: The COP-related ICD-CM codes alone did not accurately identify COP patients, but accuracy improved after including oxygen therapy data with the ICD-CM codes in Taiwan's claims data.

SUBMITTER: Chiang MY

PROVIDER: S-EPMC9240270 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Poisoning with carbon monoxide (CO) remains an important cause of accidental and intentional injury worldwide. Several unblinded non-randomized trials have suggested that the use of hyperbaric oxygen (HBO) prevents the development of neurological sequelae. This has led to the widespread use of HBO in the management of patients with carbon monoxide poisoning. OBJECTIVES:To examine randomised trials of the efficacy of hyperbaric oxygen (HBO) compared to normobaric oxygen (NBO) for the prevention of neurologic sequelae in patients with acute carbon monoxide poisoning. SEARCH STRATEGY:We searched the following electronic databases; Cochrane Injuries Group Specialised Register (searched June 2010), Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 2), MEDLINE (Ovid SP) 1950 to June 2010, EMBASE (Ovid SP) 1980 to June 2010, ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED) 1970 to June 2010, ISI Web of Science: Conference Proceedings Citation Index-Science (CPCI-S) 1990 to June 2010. SELECTION CRITERIA:All randomised controlled trials of HBO compared to NBO, involving non-pregnant adults who are acutely poisoned with carbon monoxide (regardless of severity). DATA COLLECTION AND ANALYSIS:Two authors independently extracted from each trial information on: the number of randomised patients, types of participants, the dose and duration of the intervention, and the prevalence of neurologic symptoms at follow-up. MAIN RESULTS:Seven randomised controlled trials of varying quality were identified; one was excluded because it did not evaluate clinical outcomes. Of the six remaining trials involving 1361 participants, two found a beneficial effect of HBO for the reduction of neurologic sequelae at one month, while four others did not. One of these is an incomplete publication (an abstract of an interim analysis). Although pooled random effects meta-analysis does not suggest a significant benefit from HBOT (OR for neurological deficits 0.78, 95%CI 0.54 to 1.12), significant methodologic and statistical heterogeneity was apparent among the trials, and this result should be interpreted cautiously. Moreover, design or analysis flaws were evident in all trials. Importantly, the conclusions of one positive trial may have been influenced by failure to adjust for multiple hypothesis testing, while interpretation of the other positive trial is hampered by a high risk of bias introduced during the analysis including an apparent change in the primary outcome. Both were also stopped early 'for benefit', which is likely to have inflated the observed effect. In contrast three negative trials had low power to detect a benefit of HBO due to exclusion of severely poisoned patients in two and very poor follow-up in the other. One trial that was said to be finished around eight years ago has not reported the final analysis in any forum. AUTHORS' CONCLUSIONS:Existing randomised trials do not establish whether the administration of HBO to patients with carbon monoxide poisoning reduces the incidence of adverse neurologic outcomes. Additional research is needed to better define the role, if any, of HBO in the treatment of patients with carbon monoxide poisoning. This research question is ideally suited to a multi-center randomised controlled trial.

Project description:ContextCarbon monoxide (CO) exposure can be life-threatening. Suspected and confirmed cases of CO poisoning warranting health care in New York City (NYC) are reportable to the NYC Poison Control Center (PCC).ObjectivesWe evaluated 4 hospital-based sources of CO surveillance data to identify ways to improve data capture and reporting.DesignSuspected and confirmed CO poisoning records from October 2015 through December 2016 were collected from the NYC emergency department (ED) syndromic surveillance system, New York State Statewide Planning and Research Cooperative System (SPARCS) ED billing data, NYC PCC calls made from hospitals, and the Electronic Clinical Laboratory Reporting System (ECLRS). Syndromic and SPARCS records were person- and visit-matched. SPARCS and ECLRS records were also matched to PCC records on combinations of name, demographic characteristics, and visit information.SettingHospitals in NYC.ParticipantsIndividuals who visited NYC hospitals for CO-related health effects.Main outcome measuresWe assessed the validity of syndromic data, with SPARCS records as the gold standard. We matched SPARCS and ECLRS records to PCC records to analyze reporting rates by case characteristics.ResultsThe sensitivity of syndromic surveillance was 60% (225 true-positives detected among 372 visit-matched SPARCS cases), and positive predictive value was 46%. Syndromic records often missed CO flags because of a nonspecific or absent International Classification of Diseases code in the diagnosis field. Only 15% of 428 SPARCS records (total includes 56 records not visit-matched to syndromic) and 16% of 199 ECLRS records were reported to PCC, with male sex and younger age associated with higher reporting.ConclusionsMandatory reporting makes PCC useful for tracking CO poisoning in NYC, but incomplete reporting and challenges in distinguishing between confirmed and suspected cases limit its utility. Simultaneous tracking of the systems we evaluated can best reveal surveillance patterns.

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Validation of Diagnostic Codes to Identify Carbon Monoxide Poisoning in Taiwan's Claims Data.

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