1
|
Lee S, Shaheen AA, Campbell DJT, Naugler C, Jiang J, Walker RL, Quan H, Lee J. Evaluating the coding accuracy of type 2 diabetes mellitus among patients with non-alcoholic fatty liver disease. BMC Health Serv Res 2024; 24:218. [PMID: 38365631 PMCID: PMC10874028 DOI: 10.1186/s12913-024-10634-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/24/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) describes a spectrum of chronic fattening of liver that can lead to fibrosis and cirrhosis. Diabetes has been identified as a major comorbidity that contributes to NAFLD progression. Health systems around the world make use of administrative data to conduct population-based prevalence studies. To that end, we sought to assess the accuracy of diabetes International Classification of Diseases (ICD) coding in administrative databases among a cohort of confirmed NAFLD patients in Calgary, Alberta, Canada. METHODS The Calgary NAFLD Pathway Database was linked to the following databases: Physician Claims, Discharge Abstract Database, National Ambulatory Care Reporting System, Pharmaceutical Information Network database, Laboratory, and Electronic Medical Records. Hemoglobin A1c and diabetes medication details were used to classify diabetes groups into absent, prediabetes, meeting glycemic targets, and not meeting glycemic targets. The performance of ICD codes among these groups was compared to this standard. Within each group, the total numbers of true positives, false positives, false negatives, and true negatives were calculated. Descriptive statistics and bivariate analysis were conducted on identified covariates, including demographics and types of interacted physicians. RESULTS A total of 12,012 NAFLD patients were registered through the Calgary NAFLD Pathway Database and 100% were successfully linked to the administrative databases. Overall, diabetes coding showed a sensitivity of 0.81 and a positive predictive value of 0.87. False negative rates in the absent and not meeting glycemic control groups were 4.5% and 6.4%, respectively, whereas the meeting glycemic control group had a 42.2% coding error. Visits to primary and outpatient services were associated with most encounters. CONCLUSION Diabetes ICD coding in administrative databases can accurately detect true diabetic cases. However, patients with diabetes who meets glycemic control targets are less likely to be coded in administrative databases. A detailed understanding of the clinical context will require additional data linkage from primary care settings.
Collapse
Affiliation(s)
- Seungwon Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada.
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Alberta Health Services, Calgary, AB, Canada.
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Abdel Aziz Shaheen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David J T Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jason Jiang
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Robin L Walker
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joon Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
2
|
Chen Y, Liu X, Chen S. Hirschsprung disease in an adult masquerading as stricturing Crohn's disease: a missed rare co-morbidity. Gastroenterol Rep (Oxf) 2023; 11:goad040. [PMID: 37398929 PMCID: PMC10313419 DOI: 10.1093/gastro/goad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/30/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- Yiqian Chen
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Xiaowei Liu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Shuijiao Chen
- Corresponding author. Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P. R. China. Tel: +86-731-89753723;
| |
Collapse
|
3
|
Nava de Escalante Y, Abayomi A, Langlois S, Ye X, Erickson A, Ngo H, Armour R, Okamoto R, Arbour L, Bedard T, Der K, Van Allen M, Skarsgard E, Lavoie M, Henry B. Validation of case definition algorithms for the ascertainment of congenital anomalies. Birth Defects Res 2023; 115:302-317. [PMID: 36369700 PMCID: PMC10099451 DOI: 10.1002/bdr2.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/06/2022] [Accepted: 09/25/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Congenital anomalies (CA) are one of the leading causes of infant mortality and long-term disability. Many jurisdictions rely on health administrative data to monitor these conditions. Case definition algorithms can be used to monitor CA; however, validation of these algorithms is needed to understand the strengths and limitations of the data. This study aimed to validate case definition algorithms used in a CA surveillance system in British Columbia (BC), Canada. METHODS A cohort of births between March 2000 and April 2002 in BC was linked to the Health Status Registry (HSR) and the BC Congenital Anomalies Surveillance System (BCCASS) to identify cases and non-cases of specific anomalies within each surveillance system. Measures of algorithm performance were calculated for each CA using the HSR as the reference standard. Agreement between both databases was calculated using kappa coefficient. The modified Standards for Reporting Diagnostic Accuracy guidelines were used to enhance the quality of the study. RESULTS Measures of algorithm performance varied by condition. Positive predictive value (PPV) ranged between approximately 73%-100%. Sensitivity was lower than PPV for most conditions. Internal congenital anomalies or conditions not easily identifiable at birth had the lowest sensitivity. Specificity and negative predictive value exceeded 99% for all algorithms. CONCLUSION Case definition algorithms may be used to monitor CA at the population level. Accuracy of algorithms is higher for conditions that are easily identified at birth. Jurisdictions with similar administrative data may benefit from using validated case definitions for CA surveillance as this facilitates cross-jurisdictional comparison.
Collapse
Affiliation(s)
| | - Aanu Abayomi
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Sylvie Langlois
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Xibiao Ye
- British Columbia Ministry of Health, Victoria, British Columbia, Canada.,Health Information Science, University of Victoria, Vancouver, British Columbia, Canada
| | - Anders Erickson
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Henry Ngo
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Rosemary Armour
- British Columbia Vital Statistics Agency, Vancouver, British Columbia, Canada
| | - Reiko Okamoto
- British Columbia Ministry of Health, Victoria, British Columbia, Canada.,Digital Technologies Research Centre, National Research Council Canada, Ottawa, Ontario, Canada
| | - Laura Arbour
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Community Genetics Research Program/Island Medical Program, University of Victoria, Victoria, British Columbia, Canada
| | - Tanya Bedard
- Health Standards, Quality and Performance, Alberta Health, Edmonton, Alberta, Canada
| | - Kenny Der
- Health Information Science, University of Victoria, Vancouver, British Columbia, Canada
| | - Margot Van Allen
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Medical Genetics, Vancouver Island Health Authority, Vancouver, British Columbia, Canada
| | - Erik Skarsgard
- Department of Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Martin Lavoie
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | - Bonnie Henry
- British Columbia Ministry of Health, Victoria, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
4
|
Sutthatarn P, Lapidus-Krol E, Smith C, Halaweish I, Rialon K, Ralls MW, Rentea RM, Madonna MB, Haddock C, Rocca AM, Gosain A, Frischer J, Piper H, Goldstein AM, Saadai P, Durham MM, Dickie B, Jafri M, Langer JC. Hirschsprung-associated inflammatory bowel disease: A multicenter study from the APSA Hirschsprung disease interest group. J Pediatr Surg 2023; 58:856-861. [PMID: 36801072 DOI: 10.1016/j.jpedsurg.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND/PURPOSE A small number of Hirschsprung disease (HD) patients develop inflammatory bowel disease (IBD)-like symptoms after pullthrough surgery. The etiology and pathophysiology of Hirschsprung-associated IBD (HD-IBD) remains unknown. This study aims to further characterize HD-IBD, to identify potential risk factors and to evaluate response to treatment in a large group of patients. METHODS Retrospective study of patients diagnosed with IBD after pullthrough surgery between 2000 and 2021 at 17 institutions. Data regarding clinical presentation and course of HD and IBD were reviewed. Effectiveness of medical therapy for IBD was recorded using a Likert scale. RESULTS There were 55 patients (78% male). 50% (n = 28) had long segment disease. Hirschsprung-associated enterocolitis (HAEC) was reported in 68% (n = 36). Ten patients (18%) had Trisomy 21. IBD was diagnosed after age 5 in 63% (n = 34). IBD presentation consisted of colonic or small bowel inflammation resembling IBD in 69% (n = 38), unexplained or persistent fistula in 18% (n = 10) and unexplained HAEC >5 years old or unresponsive to standard treatment in 13% (n = 7). Biological agents were the most effective (80%) medications. A third of patients required a surgical procedure for IBD. CONCLUSION More than half of the patients were diagnosed with HD-IBD after 5 years old. Long segment disease, HAEC after pull through operation and trisomy 21 may represent risk factors for this condition. Investigation for possible IBD should be considered in children with unexplained fistulae, HAEC beyond the age of 5 or unresponsive to standard therapy, and symptoms suggestive of IBD. Biological agents were the most effective medical treatment. LEVEL OF EVIDENCE Level 4.
Collapse
Affiliation(s)
- Pattamon Sutthatarn
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada; Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Eveline Lapidus-Krol
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Caitlin Smith
- Department of Surgery, Division of Pediatric and Thoracic Surgery, The University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Ihab Halaweish
- Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kristy Rialon
- Department of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Matthew W Ralls
- UMICH University of Michigan Section of Pediatric Surgery, C. S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Rebecca M Rentea
- Department of Pediatric Surgery, University of Missouri-Kansas City School of Medicine, Children's Mercy Hospital, Kansas City, MO, USA
| | - Mary B Madonna
- Department of Surgery, Rush Medical College, Department of Pediatrics, Division of Pediatric Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Candace Haddock
- Department of Pediatric Surgery, Valley Children's Healthcare, Madera, CA, USA
| | | | - Ankush Gosain
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Children's Foundation Research Institute Memphis, TN, USA
| | - Jason Frischer
- Division of Pediatric General and Thoracic Surgery Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Hannah Piper
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Allan M Goldstein
- Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Payam Saadai
- Department of Pediatric Surgery, UC Davis Children's Hospital, UC Davis Medical Center, Sacramento, CA, USA
| | - Megan M Durham
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta/Emory Pediatric Institute, Atlanta, GA, USA
| | - Belinda Dickie
- Department of Surgery, Harvard Medical School, Children's Harvard, Boston, MA, USA
| | - Mubeen Jafri
- Department of Surgery, Division of Pediatric Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Jacob C Langer
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
5
|
Abstract
Hirschsprung's disease (HD) is one of the most common causes of pediatric bowel obstruction in low- and middle-income countries (LMICs). This paper describes the unique aspects of presentation, diagnosis, management and post-operative care and outcomes of HD in LMICs. In LMICs, patients with HD are much more likely to present in a delayed fashion with subsequent increased morbidity and mortality including higher rates of chronic obstruction, malnutrition with failure to thrive, complete obstruction and perforation. There are multifactorial causes for delay, with opportunities to improve initial timely diagnosis and referral, support families to address socioeconomic and cultural barriers, and improve workforce and infrastructure resources to provide definitive care. In LMICs, the diagnosis is often made based on clinical presentation and radiographic findings as pathological services may be limited. Initial diversion with multi-stage procedure, instead of a single-stage pull-through, predominates. This is also a result of multifactorial causes, including initial presentation to general surgeons at first-level hospitals instead of pediatric surgeons, delayed presentation with sick, malnourished children with significantly distended bowel, and a lack of fresh-frozen pathological services to guide the extent of resection. Post-operatively, HD patients in LMICs experience higher complication and mortality rates - likely stemming from sicker baseline presentations and more limited resources. Significant recent advances in care have occurred for patients with HD in LMICs, while opportunities to continue to improve care remain.
Collapse
|
6
|
Bernstein CN, Kuenzig ME, Coward S, Nugent Z, Nasr A, El-Matary W, Singh H, Kaplan GG, Benchimol EI. Increased Incidence of Inflammatory Bowel Disease After Hirschsprung Disease: A Population-based Cohort Study. J Pediatr 2021; 233:98-104.e2. [PMID: 33545193 DOI: 10.1016/j.jpeds.2021.01.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/08/2021] [Accepted: 01/26/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the frequency with which inflammatory bowel disease (IBD) is diagnosed in persons with Hirschsprung disease in population-based datasets from 3 Canadian provinces. STUDY DESIGN In study I, Ontario data were used to assess the incidence of IBD in a birth cohort of children with Hirschsprung disease relative to children without Hirschsprung disease. In study II, a case-control design was used in Alberta and Manitoba to determine the frequency of previously diagnosed Hirschsprung disease in persons with IBD, compared with the frequency of Hirschsprung disease in matched controls. Validated algorithms for Hirschsprung disease and IBD were applied to each provincial health registry. RESULTS In study I, of the 716 children diagnosed with Hirschsprung disease in Ontario since 1991, 18 (2.5%) ultimately developed IBD (168.8 per 100 000 person-years), compared with 7109 of 3 377 394 children without Hirschsprung disease (0.2%, 14.2 per 100 000 person-years). The percentage of males with post-Hirschsprung disease IBD was 77.8%. The incidence rate ratio was 11.9 (95% CI, 7.5-18.8). In study II, the OR of having had Hirschsprung disease before a diagnosis of IBD compared with controls was 74.9 (95% CI, 17.1-328.7) in Alberta and 23.8 (95% CI, 4.6-123) in Manitoba. Crohn's disease was more common after Hirschsprung disease than ulcerative colitis. CONCLUSIONS IBD can emerge in more than 2% of patients with Hirschsprung disease and, like Hirschsprung disease itself, is more common in males. IBD is much more common after a diagnosis of Hirschsprung disease than in the general population.
Collapse
Affiliation(s)
- Charles N Bernstein
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - M Ellen Kuenzig
- Children's Hospital of Eastern Ontario (CHEO) Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada
| | - Stephanie Coward
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Zoann Nugent
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed Nasr
- Department of Pediatric Surgery, Children's Hospital of Eastern Ontario and Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Wael El-Matary
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba and Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Harminder Singh
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Eric I Benchimol
- Children's Hospital of Eastern Ontario (CHEO) Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada; Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
7
|
Nasr A, Grandpierre V, Sullivan KJ, Wong CA, Benchimol EI. Long-term Outcomes of Patients Surgically Treated for Hirschsprung Disease. J Can Assoc Gastroenterol 2020; 4:201-206. [PMID: 34617001 PMCID: PMC8489523 DOI: 10.1093/jcag/gwaa026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/14/2020] [Indexed: 01/04/2023] Open
Abstract
Background The only curative treatment for Hirschsprung disease (HD) is surgical repair. However, some patients experience poor postoperative outcomes. We determined long-term outcomes of all HD patients in Ontario, Canada’s most populous province. Methods We conducted a retrospective cohort study including all children with HD born between April 1, 1991 and March 31, 2014 in Ontario using linked health administrative data. Each HD case was matched to five non-HD controls on sex, date of birth, region of residence and income and followed to March 31, 2016. Chronic diarrhea and constipation were identified using combinations of outpatient physician billing codes in both HD patients and non-HD residents of the province. We determined risk factors associated with diarrhea and constipation, including surgery type and sociodemographic characteristics, using multivariable conditional logistic regression, and reported adjusted odds ratios (aORs). Results There were 3,265,172 children born in the study period, of whom 673 had HD. Compared to controls, chronic constipation was more common in HD patients (27.5% versus 2.1%; aOR 17.2, 95% CI 12.6 to 23.4), as was chronic diarrhea (29.9% versus 6.9%, aOR 5.22, 95% CI 4.19 to 6.50). In HD patients, older age at surgery was associated with increased risk of chronic constipation (OR 2.71, 95% CI 1.75 to 4.20). Surgery type, sex, rural/urban residence and income were not associated with risk of chronic constipation or diarrhea. Conclusion Chronic constipation and diarrhea were common following surgery for HD. Older age at surgery was associated with subsequent risk of chronic constipation. Surgery type was not associated with increased risk of chronic constipation or diarrhea.
Collapse
Affiliation(s)
- Ahmed Nasr
- Department of Pediatric Surgery, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.,CHEO Research Institute, Ottawa, Ontario, Canada
| | - Viviane Grandpierre
- Department of Pediatric Surgery, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Katrina J Sullivan
- Department of Pediatric Surgery, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | | | - Eric I Benchimol
- CHEO Research Institute, Ottawa, Ontario, Canada.,ICES uOttawa, Ottawa, Ontario, Canada.,Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada.,Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
8
|
McKelvie B, Pianosi K, Chan J, Tsampalieros A, Benchimol EI, Macdonald KI, Strychowshy J, Vaccani JP, McNally JD. Development and validation of an algorithm of diagnostic and procedural codes for the identification of children hospitalized with a tracheostomy in Ontario, Canada. Pediatr Pulmonol 2020; 55:1503-1511. [PMID: 32250033 DOI: 10.1002/ppul.24757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/11/2020] [Accepted: 03/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The requirement for a tracheostomy in children is associated with significant morbidity, mortality, and healthcare utilization. Easy identification of children with tracheostomies would facilitate important research on this population and provide quality improvement initiatives. AIM The purpose of this study is to determine whether an algorithm of diagnostic and procedural codes can accurately identify children hospitalized with a tracheostomy using routinely collected health data. METHODS Chart reviews were performed at the Children's Hospital of Eastern Ontario (CHEO) and the London Health Sciences Center (LHSC) to establish a true positive cohort of pediatric patients with tracheostomies admitted between 2008 and 2016. A multidisciplinary team developed algorithms of diagnostic and procedural codes contained within the Canadian Institute for Health Information Discharge Abstract Database. Algorithms were tested and refined against the true-positive and true-negative cohort. The accuracy of the diagnostic codes related to tracheostomy complications was also evaluated. RESULTS A chart review identified 158 unique children with tracheostomies (77 at CHEO, 81 at LHSC) with 901 individual admissions (401 at CHEO, 507 at LHSC). The best algorithms for identifying children with a tracheostomy had a sensitivity and specificity of more than 99%, a positive predictive value (PPV) of 94.0% and negative predictive value (NPV) of 100%. The algorithm for the identification of tracheostomy-related complications had a sensitivity of 76.7%, a specificity of 65%, PPV of 52.3%, and an NPV of 84.7%. CONCLUSIONS This study provides an algorithm for the accurate identification of children hospitalized in Canada with a tracheostomy, facilitating population-level epidemiological research and quality improvement initiatives.
Collapse
Affiliation(s)
- Brianna McKelvie
- Department of Pediatrics, Children's Hospital of Western Ontario, London, Ontario, Canada
| | - Kiersten Pianosi
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Center, Western University, London, Ontario, Canada
| | - Jason Chan
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Anne Tsampalieros
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Eric I Benchimol
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,ICES uOttawa, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kristian I Macdonald
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Strychowshy
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Center, Western University, London, Ontario, Canada
| | - Jean-Philippe Vaccani
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - James D McNally
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
9
|
Anderson JE, Vanover MA, Saadai P, Stark RA, Stephenson JT, Hirose S. Epidemiology of Hirschsprung disease in California from 1995 to 2013. Pediatr Surg Int 2018; 34:1299-1303. [PMID: 30324568 DOI: 10.1007/s00383-018-4363-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE This study seeks to update current epidemiology of Hirschsprung disease (HD) in California. METHODS Using data from the California Office of Statewide Health Planning and Development Linked Birth (1995-2012) and Patient Discharge Databases (1995-2013), patients from either dataset with an ICD-9 diagnosis code of HD (751.3) or procedure code of Soave (48.41), Duhamel (48.65), or Swenson/other pull-through (48.49) were included. Patients > age 18 during their first admission were excluded. RESULTS Of 9.3 million births, 2,464 patients were identified. Incidence was 2.2 cases/10,000 live births, with rates peaking at 2.9/10,000 births in 2002. Incidence was highest among African American (4.1/10,000) and Asian/Pacific Islander (2.5/10,000) births. Most were male (n = 1652, 67.1%). Sixty patients (2.4%) had Down syndrome. The median gestational age at birth was 38 weeks 6 days (interquartile range [IQR] 37 weeks 1 day-40 weeks 1 day). Mortality during the first year of life was 1.7%. Median age at death was 14.5 days (IQR 0-113 days). CONCLUSION This is one of the largest population-based studies of HD. In California, the incidence of HD is stable, risk is highest among African American children, and the mortality rate is < 2%.
Collapse
Affiliation(s)
- Jamie E Anderson
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, 2215 Stockton Boulevard, OP512, Sacramento, CA, 95817, USA.
| | - Melissa A Vanover
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, 2215 Stockton Boulevard, OP512, Sacramento, CA, 95817, USA
| | - Payam Saadai
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, 2215 Stockton Boulevard, OP512, Sacramento, CA, 95817, USA
| | - Rebecca A Stark
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, 2215 Stockton Boulevard, OP512, Sacramento, CA, 95817, USA
| | - Jacob T Stephenson
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, 2215 Stockton Boulevard, OP512, Sacramento, CA, 95817, USA
| | - Shinjiro Hirose
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, 2215 Stockton Boulevard, OP512, Sacramento, CA, 95817, USA
| |
Collapse
|