Journal
JOURNAL OF CLINICAL EPIDEMIOLOGY
Volume 61, Issue 6, Pages 561-571Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jclinepi.2007.08.003
Keywords
adverse drug events; patient safety; ICD-9 CM codes; E-codes; diagnostic coding; validation study
Funding
- AHRQ HHS [P01-HS11530] Funding Source: Medline
- NIA NIH HHS [5-F32-AG-026180, K23-AG-000987, K08-AG-021527] Funding Source: Medline
- NIDDK NIH HHS [K24-DK-002651] Funding Source: Medline
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Objective: We sought to examine the validity of specific hospital discharge codes in identifying drug toxicity precipitating hospitalization, among elderly users of high-risk medications. Study Design and Setting: We conducted a cross-sectional evaluation assessing the diagnostic test characteristics of International Classification of Diseases-9 External-Cause-of-Injury codes (E-codes) compared with a reference standard of medical record review. This study was nested within a prospective cohort of elders using warfarin, digoxin, or phenytoin as identified in the Pharmaceutical Assistance Contract for the Elderly benefit program. Results: We identified 4,803 subjects contributing 11,409 person-years of exposure to at least one of three drug groups. Subjects experienced 8,756 hospitalizations, of which 304 were deemed, by expert review, to be a result of an adverse event of warfarin, digoxin, or phenytoin. The sensitivity, specificity, and positive (PPVs) and negative predictive values for drug-specific E-codes were warfarin-25.5%, 98.3%, 46.6%, and 95.7%; digoxin-84.0%, 99.1%, 56.8%, and 99.8%; and phenytoin-86.7%, 98.7%, 59.1%, and 99.7%. Conclusions: E-codes for digoxin and phenytoin have a high sensitivity, but E-codes for all three medications have poor PPVs, a result that might produce misclassification in studies based solely on discharge coding. Investigators should confirm such rare events via medical record review. (c) 2008 Elsevier Inc. All rights reserved.
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