Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-07T16:32:53.555Z Has data issue: false hasContentIssue false
  • English
  • Français

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])
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Minari, A, Husni, R, Avery, RK, et al.The incidence of invasive aspergillosis among solid organ transplant recipients and implications for prophylaxis in lung transplants. Transpl Infect Dis 2002;4:195–200.CrossRefGoogle ScholarPubMed
2.Montoya, JG, Chaparro, SV, Celis, D, et al.Invasive aspergillosis in the setting of cardiac transplantation. Clin Infect Dis 2003;37(suppl 3):S281–S292.Google Scholar
3.Paterson, DL, Singh, N. Invasive aspergillosis in transplant recipients. Medicine (Baltimore) 1999;78:123–138.Google Scholar
4.Singh, N, Arnow, PM, Bonham, A, et al.Invasive aspergillosis in liver transplant recipients in the 1990s. Transplantation 1997;64:716–720.CrossRefGoogle ScholarPubMed
5.Marr, KA, Carter, RA, Boeckh, M, Martin, P, Corey, L. Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors. Blood 2002;100:4358–4366.CrossRefGoogle ScholarPubMed
6.Martino, R, Subira, M, Rovira, M, et al.Invasive fungal infections after allogeneic peripheral blood stem cell transplantation: incidence and risk factors in 395 patients. Br J Haematol 2002;116:475–482.CrossRefGoogle ScholarPubMed
7.Morgan, J, Wannemuehler, KA, Marr, KA, et al.Incidence of invasive aspergillosis following hematopoietic stem cell and solid organ transplantation: interim results of a prospective multicenter surveillance program. Med Mycol 2005;43(suppl 1):S49–S58.CrossRefGoogle ScholarPubMed
8.Jantunen, E, Ruutu, P, Niskanen, L, et al.Incidence and risk factors for invasive fungal infections in allogeneic BMT recipients. Bone Marrow Transplant 1997;19:801–808.Google Scholar
9.Marr, KA, Carter, RA, Crippa, F, Wald, A, Corey, L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis 2002;34:909–917.CrossRefGoogle ScholarPubMed
10.Keren, R, Wheeler, A, Coffin, SE, Zaoutis, T, Hodinka, R, Heydon, K. ICD-9 codes for identifying influenza hospitalizations in children. Emerglnfect Dis 2006;12:1603–1604.Google Scholar
11.Keren, R, Zaoutis, TE, Saddlemire, S, Luan, XQ, Coffin, SE. Direct medical cost of influenza-related hospitalizations in children. Pediatrics 2006;118:e1321–e1327.Google Scholar
12.Sherman, ER, Heydon, KH, St John, KH, et al.Administrative data fail to accurately identify cases of healthcare-associated infection. Infect Control Hosp Epidemiol 2006;27:332–337.CrossRefGoogle ScholarPubMed
13.Omoigui, NA, Miller, DP, Brown, KJ, et al.Outmigration for coronary bypass surgery in an era of public dissemination of clinical outcomes. Circulation 1996;93:27–33.Google Scholar
14.Schneider, EC, Epstein, AM. Influence of cardiac-surgery performance reports on referral practices and access to care: a survey of cardiovascular specialists. N Engl I Med 1996;335:251–256.CrossRefGoogle ScholarPubMed
15.Ascioglu, S, Rex, JH, de Pauw, B, et al.Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002;34:7–14.Google Scholar
16.Singh, N, Paterson, DL. Aspergillus infections in transplant recipients. Clin Microbiol Rev 2005;18:44–69.Google Scholar
17.Dasbach, EJ, Davies, GM, Teutsch, SM. Burden of aspergillosis-related hospitalizations in the United States. Clin Infect Dis 2000;31:1524–1528.Google Scholar