Key result
Novel cardiovascular severe maternal morbidity composite yields ~58% positive predictive value but low sensitivity.
Why the study?
Cardiovascular severe maternal morbidity is rising and is the leading cause of maternal mortality, but validated metrics for administrative datasets are needed.
Does an ICD-based composite variable accurately identify cardiovascular severe maternal morbidity in delivery hospitalizations?
Does an ICD-based composite variable accurately identify cardiovascular severe maternal morbidity in delivery hospitalizations?
A novel ICD-based composite variable for cardiovascular severe maternal morbidity demonstrates high specificity and reasonable positive predictive value, though limited sensitivity, making it potentially useful for epidemiologic studies.
May aid epidemiologic research on cardiovascular severe maternal morbidity despite modest sensitivity; leaves open need for refined administrative algorithms.
Background Cardiovascular severe maternal morbidity (CSMM) is rising and has become the leading cause of maternal mortality. Research using administrative data sets may allow for better understanding of this critical group of diseases. Objective To validate a composite variable of CSMM for use in epidemiologic studies. Methods We analysed delivery hospitalisations at an obstetric teaching hospital from 2007 to 2017. We utilised a subset of indicators developed by the Centers for Disease Control and Prevention based on ICD codes to form the composite variable for CSMM. Two expert clinicians manually reviewed all qualifying events using a standardised tool to determine whether these represented true CSMM events. Additionally, we estimated the number of CSMM cases among delivery hospitalisations without qualifying ICD codes by manually reviewing all hospitalisations with severe preeclampsia, a population at high risk of CSMM, and a random sample of 1000 hospitalisations without severe preeclampsia. We estimated validity of the composite variable. Results Among 91 355 admissions for delivery, we captured 113 potential CSMM cases using qualifying ICD codes. Of these, 65 (57.5%) were true CSMM cases. Indicators for acute myocardial infarction, cardiac arrest, and cardioversion had the highest true‐positive rates (100% for all). We found an additional 70 CSMM cases in the 2102 admissions with severe preeclampsia and a single CSMM case in the random sample. Assuming a rate of 1 CSMM case per 1000 deliveries in the remaining cohort, the composite variable had a positive predictive value of 57.5% (95% CI 47,9, 66.8), a negative predictive value of 99.8% (95% CI 99.8, 99.9), a sensitivity of 29.0% (95% CI 23.2, 35.4), and a specificity of 100% (95% CI 99.9, 100.0). Conclusion A novel composite variable for CSMM had reasonable PPV but limited sensitivity. This composite variable may enable epidemiologic studies geared towards reducing maternal morbidity and mortality.
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Malhamé et al. (2020) studied this question. The novel composite variable for cardiovascular severe maternal morbidity had a positive predictive value of 57.5% and a sensitivity of 29.0% based on reviewed cases.
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