Development of an algorithm to identify serious opioid toxicity in children.
Development of an algorithm to identify serious opioid toxicity in children.
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DOI：
10.1186/s13104-015-1185-x
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发表时间：
2015-07-04
影响因子：
1.8
通讯作者：
Ray, Wayne A
中科院分区：
文献类型：
--
作者：
Chung, Cecilia P;Callahan, S Todd;Ray, Wayne A
背景：阿片类药物在儿童中的使用正在增加;因此，阿片类药物毒性可能是这一弱势群体的公共卫生问题。然而，我们不知道一个已发表的算法，以确定使用管理数据库的阿片类药物毒性的儿童病例。我们试图开发一种算法来识别它们。在审查文献和去识别计算机配置文件后，选择了与严重阿片类药物毒性一致的广泛ICD-9 CM代码集。根据这些代码，我们确定了195例参与田纳西州医疗补助计划的儿童阿片类药物毒性的潜在病例。由两名医生独立审查病历;由裁定委员会审查认为不明确的事件。病例被判定为第1组（明确/很可能），第2组（可能），或第3组（排除）。结果：在195例潜在病例中，168例（86.2%）有完整的记录进行审查，85例为确诊病例。所有代码的总体阳性预测值（PPV）为50.6%。代码的PPV表明：非故意阿片类药物过量（25/31）为80.7%;故意阿片类药物过量（15/30）为50.0%，不良事件（33/58）为56.9%，存在与阿片类药物毒性相容的体征或症状（12/47）为25.5%，2例死亡的记录中未确认病例。经证实的情况下，65.8%与阿片类药物的治疗use.CONCLUSION：对于研究利用行政索赔，以量化阿片类药物毒性的儿童发病率，我们的研究结果表明，使用一个广泛的一套筛选代码加上病历审查是很重要的，以增加案件查明的完整性。
BACKGROUND: The use of opioids is increasing in children; therefore, opioid toxicity could be a public health problem in this vulnerable population. However, we are not aware of a published algorithm to identify cases of opioid toxicity in children using administrative databases. We sought to develop an algorithm to identify them. After review of literature and de-identified computer profiles, a broad set of ICD-9 CM codes consistent with serious opioid toxicity was selected. Based on these codes, we identified 195 potential cases of opioid toxicity in children enrolled in Tennessee Medicaid. Medical records were independently reviewed by two physicians; episodes considered equivocal were reviewed by an adjudication committee. Cases were adjudicated as Group 1 (definite/probable), Group 2 (possible), or Group 3 (excluded).RESULTS: Of the 195 potential cases, 168 (86.2%) had complete records for review and 85 were confirmed cases. The overall positive predictive value (PPV) for all codes was 50.6%. The PPV for codes indicating: unintentional opioid overdose (25/31) was 80.7%; intentional opioid overdose (15/30) was 50.0%, adverse events (33/58) was 56.9%, the presence of signs or symptoms compatible with opioid toxicity (12/47) was 25.5%, and no cases were confirmed in records from the two deaths. Of the confirmed cases, 65.8% were related to therapeutic opioid use.CONCLUSION: For studies utilizing administrative claims to quantify incidence of opioid toxicity in children, our findings suggest that use of a broad set of screening codes coupled with medical record review is important to increase the completeness of case ascertainment.