Accuracy of the recording of pneumonia events in English electronic healthcare record data in patients with chronic obstructive pulmonary disease.

IF 8.5 Q1 RESPIRATORY SYSTEM
Alexander J Adamson, Constantinos Kallis, Ian Douglas, Jennifer K Quint
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引用次数: 0

Abstract

Background: In primary care, identifying pneumonia events in people with chronic obstructive pulmonary disease (COPD) may be challenging due to similarities in symptoms with COPD exacerbations and lack of diagnostic testing. This study explored the accuracy of pneumonia diagnosis coded in primary care by comparing diagnosis in primary care with diagnosis in hospital.

Methods: A study population of people with COPD in England was created using the Clinical Practice Research Datalink Aurum database linked with Hospital Episode Statistics inpatient data. Pneumonia codes only, and pneumonia code with associated clinical and/or treatment codes (chest x-ray, symptoms, antibiotics, sputum and blood culture) were used to determine pneumonia events in primary care. Events that were followed by hospitalisation within 7 days were used to estimate the positive predictive value (PPV) of pneumonia coding in primary care, using primary diagnosis of pneumonia in secondary care as the gold standard. The PPV of primary care recording of hospitalised pneumonia was also calculated.

Results: Two hundred seventy-four thousand one hundred fifty-six COPD patients were eligible for inclusion, of whom 7,560 had an eligible pneumonia event in primary care diagnosed between 2015-2019 which was not 'hospital-acquired' and was diagnosed and entered on the same day. Of the 2,094 events which were followed by hospitalisation within 7 days, 1,208 had a primary diagnosis of pneumonia in hospital, representing a PPV of pneumonia coding in primary care of 57.7% (95% CI 55.6%-59.8%). Another 284 (13.6%) were diagnosed as a COPD exacerbation and 114 (5.4%) were diagnosed as another respiratory disease. Use of additional pneumonia clinical and treatment codes had a modest effect on the PPV but substantially lowered the number of events. Of the 33,603 eligible pneumonia events identified in secondary care, only 11,445 were recorded in primary care within 42 days, representing a sensitivity of 34.1% (95% CI 33.6%-34.6%).

Conclusions: Use of primary care pneumonia codes and associated clinical and treatment codes to determine pneumonia is not recommended due to significant levels of misdiagnosis and many hospitalised events failing to be recorded in primary care.

慢性阻塞性肺病患者的英语电子医疗记录数据中肺炎事件记录的准确性。
背景:在初级医疗中,由于慢性阻塞性肺病(COPD)患者的症状与慢性阻塞性肺病(COPD)加重的症状相似,且缺乏诊断测试,因此识别慢性阻塞性肺病(COPD)患者的肺炎事件可能具有挑战性。本研究通过比较基层医疗机构的诊断与医院的诊断,探讨了基层医疗机构对肺炎诊断编码的准确性:方法:利用临床实践研究数据链 Aurum 数据库与医院病历统计住院病人数据相连接,建立了英格兰慢性阻塞性肺病患者研究人群。仅使用肺炎代码、肺炎代码及相关临床和/或治疗代码(胸部 X 光检查、症状、抗生素、痰液和血液培养)来确定初级保健中的肺炎事件。以二级医疗机构的肺炎初诊为金标准,使用 7 天内住院的事件来估算基层医疗机构肺炎编码的阳性预测值 (PPV)。同时还计算了基层医疗机构记录住院肺炎的 PPV:有 27.4156 万名慢性阻塞性肺病患者符合纳入条件,其中有 7560 名患者在 2015-2019 年期间在初级医疗机构诊断出符合条件的肺炎事件,该事件并非 "医院获得性 "肺炎,且在同一天诊断和输入。在 2,094 例 7 天内住院的事件中,1,208 例经医院初诊为肺炎,这表明初级医疗肺炎编码的 PPV 为 57.7%(95% CI 55.6%-59.8%)。另有 284 例(13.6%)被诊断为慢性阻塞性肺病加重,114 例(5.4%)被诊断为其他呼吸道疾病。使用额外的肺炎临床和治疗代码对 PPV 的影响不大,但却大大降低了事件的数量。在二级医疗机构发现的 33603 例符合条件的肺炎事件中,只有 11445 例在 42 天内由初级医疗机构进行了记录,灵敏度为 34.1%(95% CI 33.6%-34.6%):结论:不建议使用初级医疗肺炎代码及相关临床和治疗代码来确定肺炎,因为误诊率很高,而且许多住院事件未能在初级医疗中记录下来。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pneumonia
Pneumonia RESPIRATORY SYSTEM-
自引率
1.50%
发文量
7
审稿时长
11 weeks
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