An enhanced method for identifying obstetric deliveries: Implications for estimating maternal morbidity
An enhanced method for identifying obstetric deliveries: Implications for estimating maternal morbidity
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DOI：
10.1007/s10995-007-0256-6
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发表时间：
2008-07-01
影响因子：
2.3
通讯作者：
Marchbanks, Polly A.
中科院分区：
文献类型：
--
作者：
Kuklina, Elena V.;Whiteman, Maura K.;Marchbanks, Polly A.
目的产妇发病率估计医院出院数据的准确性可能会受到不完整的识别交付。在孕产妇/婴儿健康研究中，产科分娩往往仅通过产妇分娩结果代码（国际疾病分类代码= V27）来确定。我们开发了一种基于额外的分娩相关代码的增强型分娩识别方法，并将增强型方法与V27方法在识别分娩估计值和孕产妇发病率估计值方面的性能进行了比较。方法将用于识别分娩的增强和标准V27方法应用于1998-2004年医疗保健成本和利用项目全国住院患者样本的数据，这是美国住院的年度全国代表性调查。使用逻辑回归的比值比（OR）和95%置信区间（CI）来检查未使用V27方法确定的分娩预测因素。结果增强的方法识别出958，868（3.4%）比单独使用V27代码识别出的27，128，539多。严重并发症，包括严重产褥感染（OR = 3.1，95% CI 2.8-3.4），子宫切除术（OR = 6.0，95% CI 5.3-6.8），脓毒症（OR = 11.9，95%CI 10.3-13.6）和呼吸窘迫综合征（OR = 16.6，95% CI 14.4-19.2）与V27方法未识别的分娩密切相关。与增强方法相比，V27方法低估了全国严重孕产妇并发症的患病率，从重大产褥感染低估9%到呼吸窘迫综合征低估40%。结论V27编码更易漏诊有严重产科并发症的产妇。研究人员应该意识到，仅通过V27代码从住院记录中选择分娩可能会影响他们发现的准确性。
Objectives The accuracy of maternal morbidity estimates from hospital discharge data may be influenced by incomplete identification of deliveries. In maternal/infant health studies, obstetric deliveries are often identified only by the maternal outcome of delivery code (International Classification of Diseases code = V27). We developed an enhanced delivery identification method based on additional delivery-related codes and compared the performance of the enhanced method with the V27 method in identifying estimates of deliveries as well as estimates of maternal morbidity. Methods The enhanced and standard V27 methods for identifying deliveries were applied to data from the 1998-2004 Healthcare Cost and Utilization Project Nationwide Inpatient Sample, an annual nationwide representative survey of U.S. hospitalizations. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression were used to examine predictors of deliveries not identified using the V27 method. Results The enhanced method identified 958,868 (3.4%) more deliveries than the 27,128,539 identified using the V27 code alone. Severe complications including major puerperal infections (OR = 3.1, 95% CI 2.8-3.4), hysterectomy (OR = 6.0, 95% CI 5.3-6.8), sepsis (OR = 11.9, 95% CI 10.3-13.6) and respiratory distress syndrome (OR = 16.6, 95% CI 14.4-19.2) were strongly associated with deliveries not identified by the V27 method. Nationwide prevalence rates of severe maternal complications were underestimated with the V27 method compared to the enhanced method, ranging from 9% underestimation for major puerperal infections to 40% underestimation for respiratory distress syndrome. Conclusion Deliveries with severe obstetric complications may be more likely to be missed using the V27 code. Researchers should be aware that selecting deliveries from hospital stay records by V27 codes alone may affect the accuracy of their findings.