External Validation of Aspect (Algorithm for Suspected Pulmonary Embolism Confirmation and Treatment)

Bibliographic Data

ID9102566
AuthorsAdi J Klil-Drori (Center for Clinical Epidemiology, Jewish General Hospital), Adi J Klil‐Drori (0000-0001-9368-7953, Jewish General Hospital, corresponding author), Dwip Prajapati (Hematology and Hematologic Malignancies), Zhiying Liang (0009-0004-2908-1446, Clinical Neurosciences, University of Calgary, Calgary, AB), Meng Wang (0000-0001-5799-549X, Clinical Neurosciences, University of Calgary, Calgary, AB), Dominique Toupin (McGill University), Latifah Alothman (McGill University), Eddy Lang (0000-0003-0850-4337, University of Calgary), Deepa Suryanarayan (0000-0003-1712-3368, Hematology and Hematologic Malignancies), Vicky Tagalakis (0000-0003-2909-3143, Center for Clinical Epidemiology, Jewish General Hospital, corresponding author)
Year2019
Volume57
Issue8
Pagese47-e52
Publication date2019-08-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001055
PMID30608277
OpenAlexW2909535800
LanguageEN
References cited17

BACKGROUND: Administrative health care databases are increasingly being used to study pulmonary embolism (PE), but the validity of single PE codes is variable. Using data from Quebec, Canada, we developed ASPECT (Algorithm for Suspected Pulmonary Embolism Confirmation and Treatment), combining 3 components to ascertain confirmed PE: emergency department (ED) diagnoses, imaging codes, and dispensed prescriptions or hospital diagnoses. Herein, we used unrelated administrative health care databases to externally validate ASPECT. METHODS: We used ED electronic health records (ED-EHRs) to identify all residents of Calgary (Alberta, Canada) with PE codes between January and June, 2016. We applied ASPECT by identifying imaging studies in the ED-EHR, admission diagnoses in linked discharge abstract database and filled prescriptions in linked pharmacy information. Confirmed PE in ASPECT was validated against chart review in the ED-EHR. RESULTS: The cohort included 498 patients. Overall, 258 (51.9%) were managed as outpatients and 327 were adjudicated to have confirmed PE; the positive predictive value (PV) of single PE codes was 65.6%. With ASPECT the positive PV was 96.5% [95% confidence interval (CI), 94.4-98.5%] and positive likelihood ratio was 10.9 (95% CI, 6.8-15.1). The negative PV and negative likelihood ratio were 85.1% (95% CI, 80.0-90.2%) and 0.1 (95% CI, 0.0-0.1), respectively. Overall agreement of ASPECT with confirmed PE was 92.2%. Further, ASPECT was similarly robust in inpatients and outpatients and was more precise than any 2-component combination of ASPECT. CONCLUSIONS: Our findings reiterate the limitations of using single administrative codes for PE and suggest ASPECT as an acceptable tool to study PE

Algorithm · Confidence interval · Diagnosis code · Emergency department · Hazard ratio · Likelihood ratios in diagnostic testing · Medical diagnosis · Medical prescription · Population · Pulmonary embolism · Radiology · Atrial Fibrillation Management and Outcomes · Emergency Medicine · Inflammatory Biomarkers in Disease Prognosis · Internal Medicine · Medicine · Venous Thromboembolism Diagnosis and Management · Pediatrics