Validation of administrative data used for the diagnosis of upper gastrointestinal events following nonsteroidal anti-inflammatory drug prescription
Validation of administrative data used for the diagnosis of upper gastrointestinal events following nonsteroidal anti-inflammatory drug prescription
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DOI：
10.1111/j.1365-2036.2006.02985.x
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发表时间：
2006-07-15
影响因子：
7.6
通讯作者：
Richardson, P
中科院分区：
文献类型：
--
作者：
Abraham, NS;Cohen, DC;Richardson, P
背景验证退伍军人事务部（VA）的行政数据的诊断非甾体抗炎药（NSAID）相关的上消化道事件（UGIE），并制定一个诊断algorithm.Methods的退伍军人的回顾性研究，规定了一个NSAID的国家药房数据库合并与住院和门诊病人的数据，其次是主要的图表摘要。建立列联表，以便与处方NSAID但未使用UGIE的患者随机样本进行比较。多变量逻辑回归分析用于推导预测算法。推导出来后，该算法在另一个退伍军人队列中进行了验证。结果在906名患者中，606人具有UGIE诊断代码; 300人是11744名患者（对照）的随机子样本。只有161人被确诊为UGIE。诊断代码的阳性预测值（PPV）较差，但随着内镜手术代码的增加，阳性预测值从27%提高到51%。UGIE的最强预测因子是住院患者ICD-9编码胃溃疡、十二指肠溃疡和出血联合上消化道内镜检查。当仅限于≥ 65岁的患者时，该算法的PPV为73%（c-统计量0.79）。该算法的验证显示重叠的NSAID prescription.Conclusions NSAID相关的UGIE患者的PPV为80%，可以使用VA管理数据进行评估。最佳算法包括胃或十二指肠溃疡和消化道出血的住院患者ICD-9代码以及上消化道内镜检查的程序代码。
Background To validate veterans affairs (VA) administrative data for the diagnosis of nonsteroidal anti-inflammatory drug (NSAID)-related upper gastrointestinal events (UGIE) and to develop a diagnostic algorithm.Methods A retrospective study of veterans prescribed an NSAID as identified from the national pharmacy database merged with in-patient and out-patient data, followed by primary chart abstraction. Contingency tables were constructed to allow comparison with a random sample of patients prescribed an NSAID, but without UGIE. Multivariable logistic regression analysis was used to derive a predictive algorithm. Once derived, the algorithm was validated in a separate cohort of veterans.Results Of 906 patients, 606 had a diagnostic code for UGIE; 300 were a random subsample of 11 744 patients (control). Only 161 had a confirmed UGIE. The positive predictive value (PPV) of diagnostic codes was poor, but improved from 27% to 51% with the addition of endoscopic procedural codes. The strongest predictors of UGIE were an in-patient ICD-9 code for gastric ulcer, duodenal ulcer and haemorrhage combined with upper endoscopy. This algorithm had a PPV of 73% when limited to patients >= 65 years (c-statistic 0.79). Validation of the algorithm revealed a PPV of 80% among patients with an overlapping NSAID prescription.Conclusions NSAID-related UGIE can be assessed using VA administrative data. The optimal algorithm includes an in-patient ICD-9 code for gastric or duodenal ulcer and gastrointestinal bleeding combined with a procedural code for upper endoscopy.