Journal
JOURNAL OF CLINICAL EPIDEMIOLOGY
Volume 62, Issue 3, Pages 321-327Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jclinepi.2008.06.006
Keywords
Bacterial infections; Diagnostic coding; Administrative claims data; Rheumatoid arthritis; Bacterial infection classification criteria; Validation study
Funding
- Engalitcheff Arthritis Outcomes Initiative
- Maryland Chapter
- Arthritis Foundation [HS10389]
- Agency for Healthcare Research and Quality
- PhRMA Foundation [5K24AR052361-03, 1-K23-AR053351-01-A1]
- Research Starter Grant in Health Outcomes
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Objective: To evaluate diagnostic properties of International Classification of Diseases, Version 9 (ICD-9) diagnosis codes and infection criteria to identify bacterial infections among rheumatoid arthritis (RA) patients. Study Design and Setting: We performed a cross-sectional study of RA patients with and without ICD-9 codes for bacterial infections. Sixteen bacterial infection criteria were developed. Diagnostic properties of comprehensive and restrictive sets of ICD-9 codes and the infection criteria were tested against an adjudicated review of medical records. Results: Records on 462 RA patients with and 50 without purported bacterial infections were reviewed. Positive and negative predictive values of ICD-9 codes ranged from 54%-85% and 84%-100%, respectively. Positive predictive values of the medical records based criteria were 84% and 89% for definite and definite or empirically treated infections, respectively. Positive predictive value of infection criteria increased by 50% as disease prevalence increased using ICD-9 codes to enhance infection likelihood. Conclusion: ICD-9 codes alone may misclassify bacterial infections in hospitalized RA patients. Misclassification varies with the specificity of the codes used and strength of evidence required to confirm infections. Combining ICD-9 codes with infection criteria identified infections with greatest accuracy. Novel infection criteria may limit the requirement to review medical records. (C) 2008 Elsevier Inc. All rights reserved.
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