Validation of anaphylaxis in the Food and Drug Administration's Mini-Sentinel.
Validation of anaphylaxis in the Food and Drug Administration's Mini-Sentinel.
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DOI：
10.1002/pds.3505
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发表时间：
2013-11
影响因子：
2.6
通讯作者：
Andrade, Susan
中科院分区：
文献类型：
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作者：
Walsh, Kathleen E;Cutrona, Sarah L;Foy, Sarah;Baker, Meghan A;Forrow, Susan;Shoaibi, Azadeh;Pawloski, Pamala A;Conroy, Michelle;Fine, Andrew M;Nigrovic, Lise E;Selvam, Nandini;Selvan, Mano S;Cooper, William O;Andrade, Susan
开发并验证使用健康计划管理和索赔数据识别速发型过敏反应的算法的阳性预测值（PPV）。先前发表的使用ICD-9-CM编码的过敏反应阳性预测值（PPV）范围为52- 57%。我们进行了一项回顾性研究，使用八个健康计划的行政和索赔数据。使用诊断和程序代码，我们开发了一种算法，以识别2009年1月至2010年12月期间微型哨兵分布式数据库中的潜在过敏反应病例。随机抽取病历样本（N=150）进行病历摘要。两名医生裁定员审查了每个潜在病例。使用医生裁定者对病例是否符合速发型过敏反应诊断标准的判断，我们计算了算法的PPV。在收到完整病历的122例患者中，77例被医生裁定者判定为过敏反应。该算法的PPV为63.1%（95% CI：53.9%-71.7%），使用Sampson的临床标准作为金标准。PPV最高的是ICD-9-CM代码为995.0或999.4的住院患者。通过仅结合表现最好的ICD-9-CM代码，我们确定了PPV为75.0%的算法，但使用此修改后的算法仅确定了66%的速发型过敏反应病例。基于ICD-9-CM的过敏反应算法的PPV略高于之前研究中报告的PPV估计值，但仍然较低。我们能够确定一种优化PPV的算法，但对过敏性事件的敏感性较低。
To develop and validate the positive predictive value (PPV) of an algorithm to identify anaphylaxis using health plan administrative and claims data. Previously published positive predictive values (PPVs) for anaphylaxis using ICD-9-CM codes range from 52-57%. We conducted a retrospective study using administrative and claims data from eight health plans. Using diagnosis and procedure codes, we developed an algorithm to identify potential cases of anaphylaxis from the Mini-Sentinel Distributed Database between January 2009 and December 2010. A random sample of medical charts (N=150) was identified for chart abstraction. Two physician adjudicators reviewed each potential case. Using physician adjudicator judgments on whether the case met diagnostic criteria for anaphylaxis, we calculated a PPV for the algorithm. Of the 122 patients for whom complete charts were received, 77 were judged by physician adjudicators to have anaphylaxis. The PPV for the algorithm was 63.1% (95% CI: 53.9%-71.7%), using the clinical criteria by Sampson as the gold standard. The PPV was highest for inpatient encounters with ICD-9-CM codes of 995.0 or 999.4. By combining only the top performing ICD-9-CM codes, we identified an algorithm with a PPV of 75.0%, but only 66% of cases of anaphylaxis were identified using this modified algorithm. The PPV for the ICD-9-CM-based algorithm for anaphylaxis was slightly higher than PPV estimates reported in prior studies, but remained low. We were able to identify an algorithm which optimized the PPV but demonstrated lower sensitivity for anaphylactic events.