Identifying venous thromboembolism and major bleeding in emergency room discharges using administrative data

Fatimah Al-Ani; Salimah Shariff; Lenicio Siqueira; Ayman Seyam; Alejandro Lazo-Langner

doi:10.1016/j.thromres.2015.10.035

Identifying venous thromboembolism and major bleeding in emergency room discharges using administrative data

Thromb Res. 2015 Dec;136(6):1195-8. doi: 10.1016/j.thromres.2015.10.035. Epub 2015 Oct 29.

Authors

Fatimah Al-Ani¹, Salimah Shariff², Lenicio Siqueira¹, Ayman Seyam¹, Alejandro Lazo-Langner³

Affiliations

¹ Department of Medicine, Division of Hematology, University of Western Ontario, London, ON, Canada.
² Institute for Clinical Evaluative Sciences - Western (ICES Western), London, ON, Canada.
³ Department of Medicine, Division of Hematology, University of Western Ontario, London, ON, Canada; Institute for Clinical Evaluative Sciences - Western (ICES Western), London, ON, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada. Electronic address: alejandro.lazolangner@lhsc.on.ca.

PMID: 26553020
DOI: 10.1016/j.thromres.2015.10.035

Abstract

Background: Administrative data can be used to identify venous thromboembolism (VTE) and major bleeding (MB) events. However, the validity of this data in emergency room discharge records in Canada is unknown.

Methods: We conducted a single-institution retrospective chart re-abstraction study in London, Canada. We identified all adult patients with a VTE or MB code included in the mandatory Canadian Institute for Health Information National Ambulatory Care Reporting System seen at our institution between July 2002 and March 2014. VTE was defined using the International Classification of Diseases, 10th revision (ICD-10CM) codes for deep venous thrombosis (DVT), and pulmonary embolism (PE) whereas MB was defined using codes for intracerebral hemorrhage, subarachnoid hemorrhage, subdural hemorrhage, upper, and lower gastrointestinal bleeding. A random sample of 50 patients was obtained for each condition. Two abstractors independently conducted blinded diagnostic adjudication using standard criteria. Agreement was calculated using kappa statistics. Positive predictive values were calculated for VTE, MB and each diagnosis.

Results: Overall, ICD-10CM codes demonstrated very good ability to identify major bleeding events (PPV 88%). Diagnostic codes performed particularly well for all intracranial and lower gastrointestinal bleeds. In contrast, ICD-10CM codes for VTE had moderate ability (PPV 49%). Diagnostic codes for PE performed better than those for DVT.

Conclusion: Single ICD-10CM codes for venous thromboembolism have moderate predictive value for identifying DVT and PE in emergency room discharges. In contrast, codes for MB events have very good ability and it would be adequate to use them for research purposes.

MeSH terms

Canada
Data Collection*
Emergency Service, Hospital
Gastrointestinal Hemorrhage / diagnosis
Gastrointestinal Hemorrhage / therapy
Humans
International Classification of Diseases
Intracranial Hemorrhages / diagnosis
Intracranial Hemorrhages / therapy
Models, Statistical
Patient Discharge*
Predictive Value of Tests
Pulmonary Embolism / diagnosis
Pulmonary Embolism / therapy
Retrospective Studies
Venous Thromboembolism / diagnosis*
Venous Thromboembolism / therapy*
Venous Thrombosis / diagnosis
Venous Thrombosis / therapy