Predictive Value of the Present-On-Admission Indicator for Hospital-acquired Venous Thromboembolism
Bibliographic Data
| ID | 9097668 |
|---|---|
| Authors | Raman R Khanna, Raman Khanna (0000-0003-0117-075X, San Francisco General Hospital, corresponding author), Sharon B Kim (San Francisco General Hospital, corresponding author), Ian Jenkins (0000-0003-3908-5948), Robert El-Kareh, Robert El‐Kareh (0000-0003-3158-5681), Nasim Afsarmanesh, Alpesh Amin (0000-0002-9790-0245, General Department of Preventive Medicine), Heather Sand (UC Irvine Health), Andrew Auerbach, Andrew D Auerbach (0000-0001-8440-0527, San Francisco General Hospital, corresponding author), Catherine Y Chia, Catherine Chia, Gregory Maynard, Gregory A Maynard (0000-0002-2441-3980), Patrick S Romano (0000-0001-6749-3979, University of California, Davis), Richard H White (University of California, Davis) |
| Year | 2015 |
| Volume | 53 |
| Issue | 4 |
| Pages | e31-e36 |
| Publication date | 2015-04-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0b013e318286e34f |
| PMID | 23552437 |
| OpenAlex | W2085445552 |
| Language | EN |
| Citations received | 3 |
| References cited | 10 |
BACKGROUND: Hospital-acquired venous thromboembolic (HA-VTE) events are an important, preventable cause of morbidity and death, but accurately identifying HA-VTE events requires labor-intensive chart review. Administrative diagnosis codes and their associated "present-on-admission" (POA) indicator might allow automated identification of HA-VTE events, but only if VTE codes are accurately flagged "not present-on-admission" (POA=N). New codes were introduced in 2009 to improve accuracy. METHODS: We identified all medical patients with at least 1 VTE "other" discharge diagnosis code from 5 academic medical centers over a 24-month period. We then sampled, within each center, patients with VTE codes flagged POA=N or POA=U (insufficient documentation) and POA=Y or POA=W (timing clinically uncertain) and abstracted each chart to clarify VTE timing. All events that were not clearly POA were classified as HA-VTE. We then calculated predictive values of the POA=N/U flags for HA-VTE and the POA=Y/W flags for non-HA-VTE. RESULTS: Among 2070 cases with at least 1 "other" VTE code, we found 339 codes flagged POA=N/U and 1941 flagged POA=Y/W. Among 275 POA=N/U abstracted codes, 75.6% (95% CI, 70.1%-80.6%) were HA-VTE; among 291 POA=Y/W abstracted events, 73.5% (95% CI, 68.0%-78.5%) were non-HA-VTE. Extrapolating from this sample, we estimated that 59% of actual HA-VTE codes were incorrectly flagged POA=Y/W. POA indicator predictive values did not improve after new codes were introduced in 2009. CONCLUSIONS: The predictive value of VTE events flagged POA=N/U for HA-VTE was 75%. However, sole reliance on this flag may substantially underestimate the incidence of HA-VTE
Intensive care medicine · Predictive value · Thrombosis · Value (mathematics) · Venous thromboembolism · Blood Coagulation and Thrombosis Mechanisms · Computer Science · Emergency Medicine · Heparin-Induced Thrombocytopenia and Thrombosis · Internal Medicine · Medicine · Venous Thromboembolism Diagnosis and Management
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| Citations per year | 0.33 |
|---|---|
| Citation span | 2017 - 2022 (6) |
| Highly cited | No |