Diagnostic E-codes for commonly used, narrow therapeutic index medications poorly predict adverse drug events
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Authors
Leonard, Charles E.Haynes, Kevin
Localio, A. Russell
Hennessy, Sean
Tjia, Jennifer
Cohen, Abigail
Kimmel, Stephen E.
Feldman, Harold I.
Metlay, Joshua P.
UMass Chan Affiliations
Department of Medicine, Division of Geriatric MedicineMeyers Primary Care Institute
Document Type
Journal ArticlePublication Date
2008-06-13Keywords
Adverse Drug Reaction Reporting SystemsAged
Anti-Arrhythmia Agents
Anticoagulants
Anticonvulsants
Cross-Sectional Studies
Digoxin
Forms and Records Control
Hospitalization
Humans
International Classification of Diseases
Medical Records
Patient Discharge
Pennsylvania
Pharmaceutical Preparations
Phenytoin
Warfarin
Health Services Research
Primary Care
Metadata
Show full item recordAbstract
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.Source
J Clin Epidemiol. 2008 Jun;61(6):561-71. Epub 2008 Feb 14. Link to article on publisher's siteDOI
10.1016/j.jclinepi.2007.08.003Permanent Link to this Item
http://hdl.handle.net/20.500.14038/37050PubMed ID
18471660Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.jclinepi.2007.08.003