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Comparison of the Use of Administrative Data and an Active System for Surveillance of Invasive Aspergillosis

Published online by Cambridge University Press:  02 January 2015

Douglas C. Chang ,
Lauren A. Burwell ,
G. Marshall Lyon ,
Peter G. Pappas ,
Tom M. Chiller ,
Kathleen A. Wannemuehler ,
Scott K. Fridkin  and
Benjamin J. Park
Douglas C. Chang*
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Lauren A. Burwell
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
G. Marshall Lyon
Affiliation:
Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
Peter G. Pappas
Affiliation:
University of Alabama, Birmingham School of Medicine, Department of Medicine, Birmingham
Tom M. Chiller
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Kathleen A. Wannemuehler
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Scott K. Fridkin
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Benjamin J. Park*
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
*
Centers for Disease Control and Prevention, 1600 Clifton Rd., MS C-09, Atlanta, GA 30333 ([email protected])
Centers for Disease Control and Prevention, 1600 Clifton Rd., MS C-09, Atlanta, GA 30333 ([email protected])
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Abstract

Background.

Administrative data, such as International Classification of Diseases, Ninth Revision (ICD-9) codes, are readily available and are an attractive option for surveillance and quality assessment within a single institution or for interinstitutional comparisons. To understand the usefulness of administrative data for the surveillance of invasive aspergillosis, we compared information obtained from a system based on ICD-9 codes with information obtained from an active, prospective surveillance system, which used more extensive case-finding methods (Transplant Associated Infection Surveillance Network).

Methods.

Patients with suspected inyasive aspergillosis were identified by aspergillosis-related ICD-9 codes assigned to hematopoietic stem cell transplant recipients and solid organ transplant recipients at a single hospital from April 1, 2001, through January 31, 2005. Suspected cases were classified as proven or probable invasive aspergillosis by medical record review using standard definitions. We calculated the sensitivity and positive predictive value (PPV) of identifying invasive aspergillosis by individual ICD-9 codes and by combinations of codes.

Results.

The sensitivity of code 117.3 was modest (63% [95% confidence interval {CI}, 38%-84%]), as was the PPV (71% [95% CI, 44%-90%]); the sensitivity of code 117.9 was poor (32% [95% CI, 13%-57%]), as was the PPV (15% [95% CI, 6%-31%]). The sensitivity of codes 117.3 and 117.9 combined was 84% (95% CI, 60%-97%); the PPV of the combined codes was 30% (95% CI, 18%-44%). Overall, ICD-9 codes triggered a review of medical records for 64 medical patients, only 16 (25%) of whom had proven or probable invasive aspergillosis.

Conclusions.

A surveillance system that involved multiple ICD-9 codes was sufficiently sensitive to identify most cases of invasive aspergillosis; however, the poor PPV of ICD-9 codes means that this approach is not adequate as the sole tool used to classify cases. Screening ICD-9 codes to trigger a medical record review might be a useful method of surveillance for invasive aspergillosis and quality assessment, although more investigation is needed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 1 , January 2008 , pp. 25 - 30
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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