Validity of diagnosis and procedure codes for identifying neural tube defects in infants

doi:10.1002/pds.5128

. 2020 Nov;29(11):1489-1493.

doi: 10.1002/pds.5128. Epub 2020 Sep 15.

Validity of diagnosis and procedure codes for identifying neural tube defects in infants

T Craig Cheetham¹, Sascha Dublin², Gaia Pocobelli², Jennifer F Bobb², Susan Andrade³, Rulin C Hechter⁴, Cecilia Portugal⁴, Mercedes Munis⁴, Ladia Albertson-Junkans², Gladys Salgado², Lawrence Wong⁵, Timothy J Maarup⁶, Kecia Carroll⁷, Marie R Griffin⁸, Marsha A Raebel⁹, David Smith¹⁰, De-Kun Li¹¹, Pamala A Pawloski¹², Sengwee Toh¹³, Lockwood Taylor¹⁴, Wei Hua¹⁴, Miriam Dinatale¹⁵, Carrie Ceresa¹⁵, James P Trinidad¹⁴, Denise M Boudreau²

Affiliations

¹ Chapman University - School of Pharmacy, Irvine, California, USA.
² Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.
³ Meyers Primary Care Institute & University of Massachusetts Medical School, Worcester, Massachusetts, USA.
⁴ Kaiser Permanente Department of Research & Evaluation, Pasadena, California, USA.
⁵ The Permanente Medical Group, Clinical Genetics, Oakland, California, USA.
⁶ Southern California Permanente Medical Group, Genetics Department, Downey, California, USA.
⁷ Department of Pediatrics, Vanderbilt University Medical School, Nashville, Tennessee, USA.
⁸ Department of Health Policy, Vanderbilt University Medical School, Nashville, Tennessee, USA.
⁹ Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA.
¹⁰ Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA.
¹¹ Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
¹² HealthPartners Institute, Bloomington, Minnesota, USA.
¹³ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Research Institute, Boston, Massachusetts, USA.
¹⁴ CDER, Food and Drug Administration, Office of Surveillance and Epidemiology, Silver Spring, Maryland, USA.
¹⁵ Division of Pediatric and Maternal Health, CDER, Food and Drug Administration, Silver Spring, Maryland, USA.

PMID: 32929845
DOI: 10.1002/pds.5128

Validity of diagnosis and procedure codes for identifying neural tube defects in infants

T Craig Cheetham et al. Pharmacoepidemiol Drug Saf. 2020 Nov.

. 2020 Nov;29(11):1489-1493.

doi: 10.1002/pds.5128. Epub 2020 Sep 15.

Authors

Affiliations

¹ Chapman University - School of Pharmacy, Irvine, California, USA.
² Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.
³ Meyers Primary Care Institute & University of Massachusetts Medical School, Worcester, Massachusetts, USA.
⁴ Kaiser Permanente Department of Research & Evaluation, Pasadena, California, USA.
⁵ The Permanente Medical Group, Clinical Genetics, Oakland, California, USA.
⁶ Southern California Permanente Medical Group, Genetics Department, Downey, California, USA.
⁷ Department of Pediatrics, Vanderbilt University Medical School, Nashville, Tennessee, USA.
⁸ Department of Health Policy, Vanderbilt University Medical School, Nashville, Tennessee, USA.
⁹ Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA.
¹⁰ Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA.
¹¹ Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
¹² HealthPartners Institute, Bloomington, Minnesota, USA.
¹³ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Research Institute, Boston, Massachusetts, USA.
¹⁴ CDER, Food and Drug Administration, Office of Surveillance and Epidemiology, Silver Spring, Maryland, USA.
¹⁵ Division of Pediatric and Maternal Health, CDER, Food and Drug Administration, Silver Spring, Maryland, USA.

PMID: 32929845
DOI: 10.1002/pds.5128

Abstract

Purpose: The use of validated criteria to identify birth defects in electronic healthcare databases can avoid the cost and time-intensive efforts required to conduct chart reviews to confirm outcomes. This study evaluated the validity of various case-finding methodologies to identify neural tube defects (NTDs) in infants using an electronic healthcare database.

Methods: This analysis used data generated from a study whose primary aim was to evaluate the association between first-trimester maternal prescription opioid use and NTDs. The study was conducted within the Medication Exposure in Pregnancy Risk Evaluation Program. A broad approach was used to identify potential NTDs including diagnosis and procedure codes from inpatient and outpatient settings, death certificates and birth defect flags in birth certificates. Potential NTD cases were chart abstracted and confirmed by clinical experts. Positive predictive values (PPVs) and 95% confidence intervals (95% CI) are reported.

Results: The cohort included 113 168 singleton live-born infants: 55 960 infants with opioid exposure in pregnancy and 57 208 infants unexposed in pregnancy. Seventy-three potential NTD cases were available for the validation analysis. The overall PPV was 41% using all diagnosis and procedure codes plus birth certificates. Restricting approaches to codes recorded in the infants' medical record or to birth certificate flags increased the PPVs (72% and 80%, respectively) but missed a substantial proportion of confirmed NTDs.

Conclusions: Codes in electronic healthcare data did not accurately identify confirmed NTDs. These results indicate that chart review with adjudication of outcomes is important when conducting observational studies of NTDs using electronic healthcare data.

Keywords: diagnosis codes; neural tube defects; pharmacoepidemiology; positive predictive value; procedure codes; validation.

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References

REFERENCES

1. Watkins ML, Edmonds L, McClearn A, Mullins L, Mulinare J, Khoury M. The surveillance of birth defects: the usefulness of the revised US standard birth certificate. Am J Public Health. 1996;86(5):193-197.
1. Hexter AC, Harris JA, Roeper P, Croen LA, Krueger P, Gant D. Evaluation of the hospital discharge diagnoses index and the birth certificate as sources of information on birth defects. Public Health Rep. 1990;105(3):296-307.
1. Farley TF, Hambidge SJ, Daley MF. Association of low maternal education with neural tube defects in Colorado, 1989-1998. Public Health. 2002;116(2):89-94.
1. Boulet SL, Shin M, Kirby RS, Goodman D, Correa A. Sensitivity of birth certificate reports of birth defects in Atlanta, 1995-2005: effects of maternal, infant, and hospital characteristics. Public Health Rep. 2011;126(2):186-194.
1. Tairou F, De Wals P, Bastide A. Validity of death and stillbirth certificates and hospital discharge summaries for the identification of neural tube defects in Quebec City. Chronic Dis Can. 2006;27(3):120-124.

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[1] Watkins ML, Edmonds L, McClearn A, Mullins L, Mulinare J, Khoury M. The surveillance of birth defects: the usefulness of the revised US standard birth certificate. Am J Public Health. 1996;86(5):193-197.

[2] Watkins ML, Edmonds L, McClearn A, Mullins L, Mulinare J, Khoury M. The surveillance of birth defects: the usefulness of the revised US standard birth certificate. Am J Public Health. 1996;86(5):193-197.

[3] Hexter AC, Harris JA, Roeper P, Croen LA, Krueger P, Gant D. Evaluation of the hospital discharge diagnoses index and the birth certificate as sources of information on birth defects. Public Health Rep. 1990;105(3):296-307.

[4] Hexter AC, Harris JA, Roeper P, Croen LA, Krueger P, Gant D. Evaluation of the hospital discharge diagnoses index and the birth certificate as sources of information on birth defects. Public Health Rep. 1990;105(3):296-307.

[5] Farley TF, Hambidge SJ, Daley MF. Association of low maternal education with neural tube defects in Colorado, 1989-1998. Public Health. 2002;116(2):89-94.

[6] Farley TF, Hambidge SJ, Daley MF. Association of low maternal education with neural tube defects in Colorado, 1989-1998. Public Health. 2002;116(2):89-94.

[7] Boulet SL, Shin M, Kirby RS, Goodman D, Correa A. Sensitivity of birth certificate reports of birth defects in Atlanta, 1995-2005: effects of maternal, infant, and hospital characteristics. Public Health Rep. 2011;126(2):186-194.

[8] Boulet SL, Shin M, Kirby RS, Goodman D, Correa A. Sensitivity of birth certificate reports of birth defects in Atlanta, 1995-2005: effects of maternal, infant, and hospital characteristics. Public Health Rep. 2011;126(2):186-194.

[9] Tairou F, De Wals P, Bastide A. Validity of death and stillbirth certificates and hospital discharge summaries for the identification of neural tube defects in Quebec City. Chronic Dis Can. 2006;27(3):120-124.

[10] Tairou F, De Wals P, Bastide A. Validity of death and stillbirth certificates and hospital discharge summaries for the identification of neural tube defects in Quebec City. Chronic Dis Can. 2006;27(3):120-124.

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Validity of diagnosis and procedure codes for identifying neural tube defects in infants

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Validity of diagnosis and procedure codes for identifying neural tube defects in infants

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Abstract

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