Key result
Administrative claims using ventricular arrhythmia codes in the primary position yielded a positive predictive value of 94% for identifying out-of-hospital events in pediatric patients.
Why the study?
Administrative claims-based algorithms with high positive-predictive value needed to be identified for capturing out-of-hospital ventricular arrhythmias and cardiac arrests due to cardiac causes in children.
Do administrative claims-based algorithms accurately identify out-of-hospital ventricular arrhythmias and cardiac arrests in pediatric patients?
Cohort (n=598)
Single-blind
No
Do administrative claims-based algorithms accurately identify out-of-hospital ventricular arrhythmias and cardiac arrests in pediatric patients?
Administrative claims algorithms using cardiac arrest codes have low positive predictive value for identifying out-of-hospital ventricular arrhythmias and cardiac arrests in pediatric populations, highlighting challenges for pediatric drug safety studies.
Answers are grounded in this paper and cite their sources.
Enhances claims-based ascertainment of pediatric out-of-hospital arrhythmias; extends adult validations but leaves generalizability open.
PURPOSE: Identify administrative claims-based algorithms for capturing out-of-hospital ventricular arrhythmias (VA) and cardiac arrests (CA) due to cardiac causes in the pediatric population with high positive-predictive value (PPV). METHODS: Within a single pediatric center, a retrospective cohort of patients hospitalized or seen in the emergency room for VA or CA were identified from the electronic health records. Eligible encounters were blindly reviewed and linked to administrative data, including ICD-9/ICD-10 codes. Test characteristics, including PPV, for different diagnostic and procedure codes were generated using a 50% training sample. The gold standard was definite or suspected out-of-hospital VA or CA due to cardiac cause verified based on clinical criteria. Algorithms with the highest PPV were then applied to a 50% validation sample to validate performance. RESULTS: From 2004-2017, 598 encounters met eligibility criteria. 174 (29%) had an outcome of interest, with remainder being an inpatient event or CA due to other cause. Within the training sample (n = 263), VA codes in primary position had a PPV 94% (95%CI 81%-99%) with low sensitivity (44%, 95%CI 33%-56%). CA codes in any position or VA codes in nonprimary positions had low PPV (18%-19%, 31% respectively). Applying the top three performing algorithms to the validation sample (n = 252) yielded similar PPV values. CONCLUSIONS: Contrary to adults, algorithms including a CA code do not perform well for identifying out-of-hospital VA and CA due to cardiac cause in the pediatric populations. Researchers should be aware of the potential implications for future pediatric drug safety studies for these outcomes.
No takes yet. Share an insight, caveat, or question.
Czaja et al. (2020) conducted a cohort in Ventricular arrhythmia and cardiac arrest (n=598). Administrative claims-based algorithms (VA codes in primary position) vs. Clinical criteria (gold standard) was evaluated on Positive-predictive value (PPV) for out-of-hospital VA or CA due to cardiac cause (95% CI 81-99). Administrative claims using ventricular arrhythmia codes in the primary position yielded a positive predictive value of 94% for identifying out-of-hospital events in pediatric patients.
Synapse has enriched 10 related papers. Consider them for comparative context: