Key result
The AHRQ Patient Safety Indicator-12 yielded a positive predictive value of 79% for any acute VTE, but only 44% to 48% for acute postoperative lower extremity DVT or PE.
Why the study?
Does the AHRQ Patient Safety Indicator-12 accurately identify patients with postoperative venous thromboembolism?
Observational (n=573)
Yes
Does the AHRQ Patient Safety Indicator-12 accurately identify patients with postoperative venous thromboembolism?
The AHRQ PSI-12 criteria based on ICD-9-CM codes have a low positive predictive value for accurately identifying clinically important acute postoperative lower extremity DVT or PE.
PSI-12 should not guide postoperative VTE identification without validation; leaves open its reliability in administrative datasets.
BACKGROUND: Hospital administrative data are being used to identify patients with postoperative venous thromboembolism (VTE), either pulmonary embolism (PE) or deep-vein thrombosis (DVT). However, few studies have evaluated the accuracy of these ICD-9-CM codes across multiple hospitals. METHODS AND MATERIALS: The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI)-12 was used to identify cases with postoperative VTE in 80 hospitals that volunteered for either an AHRQ or University HealthSystem Consortium (UHC) validation project. Trained abstractors using a standardized tool and guidelines retrospectively verified all coded VTE events. RESULTS: In the combined samples, the positive predictive value of the set of prespecified VTE codes for any acute VTE at any time during the hospitalization was 451 of 573 = 79% (95% CI: 75%-82%). However, the positive predictive value for acute lower extremity DVT or PE diagnosed after an operation was 209 of 452 = 44% (95% CI: 37%-51%) in the UHC sample and 58 of 121 = 48% (95% CI: 42-67%) in the AHRQ sample. Fourteen percent of all cases had an acute upper extremity DVT, 6% had superficial vein thrombosis and 21% had no acute VTE, however, 61% of the latter had a documented prior/chronic VTE. In the UHC cohort, the sensitivity for any acute VTE was 95.5% (95% CI: 86.4%-100%); the specificity was 99.5% (95% CI: 99.4%-99.7%). CONCLUSION: Current PSI 12 criteria do not accurately identify patients with acute postoperative lower extremity DVT or PE. Modification of the ICD-9-CM codes and implementation of "present on admission" flags should improve the predictive value for clinically important VTE events.
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White et al. (2009) conducted an observational in Postoperative venous thromboembolism (n=573). AHRQ Patient Safety Indicator (PSI)-12 vs. Retrospective chart review was evaluated on Positive predictive value for any acute VTE at any time during hospitalization (95% CI 75%-82%). The AHRQ Patient Safety Indicator-12 yielded a positive predictive value of 79% for any acute VTE, but only 44% to 48% for acute postoperative lower extremity DVT or PE.
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