The positive predictive value of a hyperkalemia diagnosis in automated health care data
The positive predictive value of a hyperkalemia diagnosis in automated health care data
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DOI：
10.1002/pds.2030
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发表时间：
2010-11-01
影响因子：
2.6
通讯作者：
Xu, Stanley
中科院分区：
文献类型：
--
作者：
Raebel, Marsha A.;Smith, Michael L.;Xu, Stanley
目的 我们的目标是确定编码高钾血症诊断在识别以下情况时的效能：（1）临床明显的高钾血症；（2）血清钾≥6 mmol/L。
方法 这项回顾性观察研究纳入了综合医疗系统内8722名新开始使用血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂或螺内酯的糖尿病患者。主要结局是治疗第一年中首次与高钾血症相关的事件（在编码诊断的24小时内住院、急诊就诊或死亡和/或钾≥6 mmol/L）。对病历进行了审查。
结果 在99名未被编码为高钾血症的随机抽样患者中，经病历审查无一例有高钾血症。在所有被确定为高钾血症的64名患者中，所有人都有与编码诊断相关的住院或急诊就诊，或血钾升高。在55名有编码诊断的患者中，42名（阳性预测值76%）有临床明显的高钾血症；32名（阳性预测值58%）血钾≥6。在仅通过血钾≥6确定的9名患者中，7名（阳性预测值78%）有临床明显的高钾血症。
结论 近四分之一有编码诊断的患者没有临床明显的高钾血症，近一半患者血钾不≥6。由于编码诊断存在假阳性和假阴性情况，对高钾血症相关结局进行病历验证是必要的。版权所有（C）2010约翰威立父子有限公司
Purpose Our objectives were to determine performance of coded hyperkalemia diagnosis at identifying (1) clinically evident hyperkalemia and (2) serum potassium >= 6 mmol/L.Methods This retrospective observational study included 8722 patients with diabetes within an integrated healthcare system who newly initiated an angiotensin converting enzyme inhibitor, angiotensin receptor blocker, or spironolactone. The primary outcome was first hyperkalemia-associated event (hospitalization, emergency department visit or death within 24 hours of coded diagnosis and/or potassium >= 6 mmol/L) during the first year of therapy. Medical records were reviewed.Results Among a random sample of 99 patients not coded as having hyperkalemia, none had hyperkalemia upon record review. Among all 64 patients identified as having hyperkalemia, all had hospitalization or emergency department visit associated with coded diagnosis or elevated potassium. Of 55 with coded diagnosis, 42 (PPV 76%) had clinically evident hyperkalemia; 32 (PPV 58%) had potassium >= 6. Of 9 identified using only potassium >= 6, 7 (PPV 78%) had clinically evident hyperkalemia.Conclusions Nearly one-fourth of patients with coded diagnosis do not have clinically evident hyperkalemia and nearly one-half do not have potassium >= 6. Because both false positives and negatives occur with coded diagnoses, medical record validation of hyperkalemia-associated outcomes is necessary. Copyright (C) 2010 John Wiley & Sons, Ltd.