Key result
OXMIS/Read diagnostic codes for sudden cardiac death and ventricular arrhythmia had a positive predictive value of only 23% (95% CI, 10-42%) for identifying outpatient events precipitating hospitalization.
Why the study?
Are OXMIS/Read diagnostic codes valid for identifying outpatient sudden cardiac death and ventricular arrhythmia events precipitating hospitalization in the GPRD?
Observational (n=84)
Are OXMIS/Read diagnostic codes valid for identifying outpatient sudden cardiac death and ventricular arrhythmia events precipitating hospitalization in the GPRD?
Computerized diagnostic codes for sudden cardiac death and ventricular arrhythmia in the GPRD have poor positive predictive value for identifying outpatient events precipitating hospitalization, necessitating case-by-case verification.
Answers are grounded in this paper and cite their sources.
OXMIS/Read codes require case verification before identifying outpatient SCD/VA events; leaves open their reliability in unvalidated GPRD research.
PURPOSE: To examine the validity of OXMIS/Read diagnoses of hospitalization for sudden cardiac death and ventricular arrhythmia (SD/VA) for use in studies of arrhythmogenic effects of outpatient medications in the General Practice Research Database (GPRD). METHODS: We identified putative occurrences of hospitalization for SD/VA in patients receiving outpatient prescriptions for cisapride, domperidone, or metoclopramide. We then administered a questionnaire to general practitioners (GPs) caring for these patients, requested hospital discharge consult letters, and examined the positive predictive value (PPV) of diagnostic codes in identifying outpatient events precipitating hospitalization. RESULTS: We identified 84 putative events, 38 (45%) of which occurred in patients cared for by GPs participating in the follow-up scheme. Thirty of 38 questionnaires (79%) were completed. The PPV for the occurrence of any SD/VA was 93% (95% CI, 78-99%). However, the PPV for SD/VA occurrence in an outpatient setting precipitating a hospitalization was only 23% (95% CI, 10-42%). The majority of inpatient diagnostic codes reflected events occurring after hospital admission, not precipitating it. CONCLUSIONS: While computerized codes for SD/VA agreed well with physician diagnosis, they operated poorly to identify events occurring in an outpatient setting. Studies of SD/VA in the GPRD should verify events on a case-by-case basis.
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Hennessy et al. (2008) conducted an observational in Sudden cardiac death and ventricular arrhythmia (n=84). OXMIS/Read diagnostic codes for SD/VA vs. Physician diagnosis via questionnaires and hospital discharge letters was evaluated on Positive predictive value (PPV) for SD/VA occurrence in an outpatient setting precipitating a hospitalization (PPV 23%, 95% CI 10-42). OXMIS/Read diagnostic codes for sudden cardiac death and ventricular arrhythmia had a positive predictive value of only 23% (95% CI, 10-42%) for identifying outpatient events precipitating hospitalization.
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