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How Valid is the ICD-9-CM Based AHRQ Patient Safety Indicator for Postoperative Venous Thromboembolism?
- Source :
- Medical Care. 47:1237-1243
- Publication Year :
- 2009
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2009.
-
Abstract
- Hospital administrative data are being used to identify patients with postoperative venous thromboembolism (VTE), either pulmonary embolism (PE) or deep-vein thrombosis (DVT). However, few studies have evaluated the accuracy of these ICD-9-CM codes across multiple hospitals.The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI)-12 was used to identify cases with postoperative VTE in 80 hospitals that volunteered for either an AHRQ or University HealthSystem Consortium (UHC) validation project. Trained abstractors using a standardized tool and guidelines retrospectively verified all coded VTE events.In the combined samples, the positive predictive value of the set of prespecified VTE codes for any acute VTE at any time during the hospitalization was 451 of 573 = 79% (95% CI: 75%-82%). However, the positive predictive value for acute lower extremity DVT or PE diagnosed after an operation was 209 of 452 = 44% (95% CI: 37%-51%) in the UHC sample and 58 of 121 = 48% (95% CI: 42-67%) in the AHRQ sample. Fourteen percent of all cases had an acute upper extremity DVT, 6% had superficial vein thrombosis and 21% had no acute VTE, however, 61% of the latter had a documented prior/chronic VTE. In the UHC cohort, the sensitivity for any acute VTE was 95.5% (95% CI: 86.4%-100%); the specificity was 99.5% (95% CI: 99.4%-99.7%).Current PSI 12 criteria do not accurately identify patients with acute postoperative lower extremity DVT or PE. Modification of the ICD-9-CM codes and implementation of "present on admission" flags should improve the predictive value for clinically important VTE events.
- Subjects :
- Adult
Male
medicine.medical_specialty
MEDLINE
Patient safety
Postoperative Complications
Sex Factors
United States Agency for Healthcare Research and Quality
International Classification of Diseases
Sex factors
Humans
Medicine
cardiovascular diseases
Intensive care medicine
Aged
Quality Indicators, Health Care
Retrospective Studies
business.industry
Age Factors
Public Health, Environmental and Occupational Health
Reproducibility of Results
Retrospective cohort study
Venous Thromboembolism
Middle Aged
medicine.disease
Thrombosis
United States
Pulmonary embolism
Multicenter study
Female
business
Venous thromboembolism
Subjects
Details
- ISSN :
- 00257079
- Volume :
- 47
- Database :
- OpenAIRE
- Journal :
- Medical Care
- Accession number :
- edsair.doi.dedup.....386ec6235129209b74b5a6ad15f3a455