Use of electronic health record data to identify skin and soft tissue infections in primary care settings: a validation study

BMC Infectious Diseases

Jessina C McGregor¹  Ian McClellan¹  Rowena Vilches-Tran¹  David T Bearden¹  John M Townes²  Ravina Kullar¹  Miriam R Elman¹  Pamela J Levine¹ 

[1] Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health & Science University, 3303 SW Bond Avenue CH12C, Portland, Oregon, 97239, USA;Division of Infectious Diseases, Department of Medicine, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road L457, Portland, Oregon, 97239, USA

关键词: Positive predictive value;    Methodologies;    Skin infection;    Primary care;    Abscess;   

Others  :  1148945
DOI  :  10.1186/1471-2334-13-171

 received in 2012-10-10, accepted in 2013-04-04,  发布年份 2013

【 摘 要 】

Background

Epidemiologic studies of skin and soft tissue infections (SSTIs) depend upon accurate case identification. Our objective was to evaluate the positive predictive value (PPV) of electronic medical record data for identification of SSTIs in a primary care setting.

Methods

A validation study was conducted among primary care outpatients in an academic healthcare system. Encounters during four non-consecutive months in 2010 were included if any of the following were present in the electronic health record: International Classification of Diseases, Ninth Revision (ICD-9) code for an SSTI, Current Procedural Terminology (CPT) code for incision and drainage, or a positive wound culture. Detailed chart review was performed to establish presence and type of SSTI. PPVs and 95% confidence intervals (CI) were calculated among all encounters, initial encounters, and cellulitis/abscess cases.

Results

Of the 731 encounters included, 514 (70.3%) were initial encounters and 448 (61.3%) were cellulitis/abscess cases. When the presence of an ICD-9 code, CPT code, or positive culture was used to identify SSTIs, 617 encounters were true positives, yielding a PPV of 84.4% [95% CI: 81.8–87.0%]. The PPV for using ICD-9 codes alone to identify SSTIs was 90.7% [95 % CI: 88.5–92.9%]. For encounters with cellulitis/abscess codes, the PPV was 91.5% [95% CI: 88.9–94.1%].

Conclusions

ICD-9 codes may be used to retrospectively identify SSTIs with a high PPV. Broadening SSTI case identification with microbiology data and CPT codes attenuates the PPV. Further work is needed to estimate the sensitivity of this method.

【 授权许可】

   
2013 Levine et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Daly JM, Levy BT, Ely JW, Swanson K, Bergus GR, Jogerst GJ, Smith TC: Management of Skin and Soft Tissue Infections in Community Practice Before and After Implementing a "Best Practice" Approach: An Iowa Research Network (IRENE) Intervention Study. J Am Board Fam Med 2011, 24(5):524-533.
• [2]Reber A, Moldovan A, Dunkel N, Emonet S, Rohner P, Tahintzi P, Hoffmeyer P, Harbarth S, Uckay I: Should the methicillin-resistant Staphylococcus aureus carriage status be used as a guide to treatment for skin and soft tissue infections. Infect 2012, 64(5):513-9.
• [3]Karamatsu ML, Thorp AW, Brown L: Changes in community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections presenting to the pediatric emergency department: comparing 2003 to 2008. Pediatr Emerg Care 2012, 28(2):131-135.
• [4]Zervos MJ, Freeman K, Vo L, Haque N, Pokharna H, Raut M, Kim M: Epidemiology and outcomes of complicated skin and soft tissue infections in hospitalized patients. J Clin Microbiol 2012, 50(2):238-245.
• [5]Pallin DJ, Espinola JA, Leung DY, Hooper DC, Camargo CA Jr: Epidemiology of dermatitis and skin infections in United States physicians' offices, 1993–2005. Clin Infect Dis 2009, 49(6):901-907.
• [6]Williams DJ, Cooper WO, Kaltenbach LA, Dudley JA, Kirschke DL, Jones TF, Arbogast PG, Griffin MR, Creech CB: Comparative effectiveness of antibiotic treatment strategies for pediatric skin and soft-tissue infections. Pediatrics 2011, 128(3):e479-487.
• [7]Tieder JS, Hall M, Auger KA, Hain PD, Jerardi KE, Myers AL, Rahman SS, Williams DJ, Shah SS: Accuracy of administrative billing codes to detect urinary tract infection hospitalizations. Pediatrics 2011, 128(2):323-330.
• [8]Ginde AA, Tsai CL, Blanc PG, Camargo CA Jr: Positive predictive value of ICD-9-CM codes to detect acute exacerbation of COPD in the emergency department. Jt Comm J Qual Patient Saf 2008, 34(11):678-680.
• [9]Stein BD, Bautista A, Schumock GT, Lee TA, Charbeneau JT, Lauderdale DS, Naureckas ET, Meltzer DO, Krishnan JA: The validity of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for identifying patients hospitalized for COPD exacerbations. Chest 2012, 141(1):87-93.
• [10]Schweizer ML, Eber MR, Laxminarayan R, Furuno JP, Popovich KJ, Hota B, Rubin MA, Perencevich EN: Validity of ICD-9-CM coding for identifying incident methicillin-resistant Staphylococcus aureus (MRSA) infections: is MRSA infection coded as a chronic disease? Infect Control Hosp Epidemiol 2011, 32(2):148-154.
• [11]Mandell GL, Bennett JE, Dolin R: Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 7th edition. Philadelphia, PA: Churchill Livingstone/Elsevier; 2010.
• [12]Bope ET, Kellerman RD, Rakel RE: Conn's Current Therapy 2011. 1st edition. Philadelphia, PA: Elsevier Saunders; 2010.
• [13]Carey WD, Cleveland Clinic Foundation: Current clinical medicine: online + print. 2nd edition. Philladelphia: Saunders/Elsevier; 2010.
• [14]Bolognia J, Jorizzo JL, Rapini RP: Dermatology. 2nd edition. St. Louis, Mo: Mosby/Elsevier; 2008.
• [15]Tracy LA, Furuno JP, Harris AD, Singer M, Langenberg P, Roghmann MC: Predictive ability of positive clinical culture results and International Classification of Diseases, Ninth Revision, to identify and classify noninvasive Staphylococcus aureus infections: a validation study. Infect Control Hosp Epidemiol 2010, 31(7):694-700.