What is the clinical evidence from this study?

Study design: Cohort. Population: Pulmonary embolism (n=1983). Intervention: Acetaminophen vs. No acetaminophen use. Primary outcome: 30-day all-cause mortality (HR 0.69, 95% CI 0.56-0.85, p=0.001).

What does this research mean for the field?

Newly created and redefined ICD-9-CM diagnosis codes substantially improved the criterion validity of AHRQ Patient Safety Indicator 12, achieving positive predictive values of 81% to 99% compared with historical values of 43% to 48%. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 2, 2013Medical Care

Improved Coding of Postoperative Deep Vein Thrombosis and Pulmonary Embolism in Administrative Data (AHRQ Patient Safety Indicator 12) After Introduction of New ICD-9-CM Diagnosis Codes

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Key result

Acetaminophen use is linked to ~31% lower 30-day mortality in critically ill PE patients.

HR 0.69
95% CI 0.56-0.85
P=0.001
n=1,983

Why the study?

Newly created and redefined ICD-9-CM codes were introduced to improve the criterion validity of AHRQ Patient Safety Indicator 12 for postoperative venous thromboembolism.

Study Design

Type

Cohort (n=1,983)

Multicenter

PICO

Population

1,983 critically ill patients with pulmonary embolism on their first ICU admission, evaluated for the association between acetaminophen use and 30-day mortality.

Exposure / Comparator

Acetaminophen vs No acetaminophen use

Primary Outcome

30-day all-cause mortality — HR 0.69 (0.56-0.85), p=0.001

Main Result

Hazard Ratio: 0.69 (95% CI 0.56–0.85)

Absolute Event Rate: 20.7% vs 26.4%

p-value: p=0.001

Limitations

Retrospective observational design cannot establish causality
Confounding by indication, as acetaminophen is typically prescribed for specific clinical indications like fever
Binary exposure classification without dose-stratified analysis
Inability to conduct ideal negative control exposure analysis
PE diagnosis relied solely on ICD-9 codes without integration of imaging or laboratory gold standards
Limited structured adverse event documentation
Residual confounding from unmeasured variables
Single-center data limits generalizability

Discussion

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Implication

Acetaminophen may lower mortality in ICU PE; retrospective data leaves open confounding and requires RCTs before any practice change.

Cite This Study

Sadeghi et al. (2013) conducted a cohort in Pulmonary embolism (n=1,983). Acetaminophen vs. No acetaminophen use was evaluated on 30-day all-cause mortality (HR 0.69, 95% CI 0.56-0.85, p=0.001). Acetaminophen use during ICU stay was associated with a 31% reduction in 30-day all-cause mortality (HR 0.69) compared to non-use in critically ill patients with pulmonary embolism.

synapsesocial.com/papers/6ac4a4a8e9dadcb56dbcb825 https://doi.org/10.1097/mlr.0b013e318287d59e

Topics

Pulmonary embolism

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Improved Coding of Postoperative Deep Vein Thrombosis and Pulmonary Embolism in Administrative Data (AHRQ Patient Safety Indicator 12) After Introduction of New ICD-9-CM Diagnosis Codes

Study Design

PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Improved Coding of Postoperative Deep Vein Thrombosis and Pulmonary Embolism in Administrative Data (AHRQ Patient Safety Indicator 12) After Introduction of New ICD-9-CM Diagnosis Codes

Study Design

PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

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