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Use of International Classification of Diseases, Ninth Revision Clinical Modification Codes and Medication Use Data to Identify Nosocomial Clostridium difficile Infection

Published online by Cambridge University Press:  02 January 2015

Mia Schmiedeskamp ,
Spencer Harpe ,
Ronald Polk ,
Michael Oinonen  and
Amy Pakyz
Mia Schmiedeskamp
Affiliation:
Department of Pharmacy, College of Pharmacy, University of Illinois at Chicago, Chicago
Spencer Harpe
Affiliation:
Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia
Ronald Polk
Affiliation:
Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia
Michael Oinonen
Affiliation:
University HealthSystem Consortium, Oak Brook, Illinois
Amy Pakyz*
Affiliation:
Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia
*
Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533 ([email protected])
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Abstract

Objective.

The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for Clostridium difficile infection (CDI) is used for surveillance of CDI. However, the ICD-9-CM code alone cannot separate nosocomial cases from cases acquired outside the institution. The purpose of this study was to determine whether combining the ICD-9-CM code with medication treatment data for CDI in hospitalized patients could enable us to distinguish between patients with nosocomial CDI and patients who were admitted with CDI. The primary objective was to compare the sensitivity, specificity, and predictive value of using the combination of ICD-9-CM code for CDI and CDI treatment records to identify cases of nosocomial CDI with the sensitivity, specificity, and predictive value of using the ICD-9-CM code alone.

Design.

Validation sample cross-sectional study.

Setting.

Academic health center.

Methods.

Administrative claims data from July 1, 2004, to June 30, 2005, were queried to identify adults discharged with an ICD-9-CM code for CDI and to find documentation of CDI therapy with oral vancomycin or metronidazole. Laboratory and medical records were queried to identify symptomatic CDI toxin-positive adult patients with nosocomial CDI and were compared with records of patients whose cases were predicted to be nosocomial by means of ICD-9-CM code and CDI therapy data.

Results.

Of 23,920 adult patients discharged from the hospital, 62 had nosocomial CDI according to symptoms and toxin assay. The sensitivity of the ICD-9-CM code alone for identifying nosocomial CDI was 96.8%, the specificity was 99.6%, the positive predictive value was 40.8%, and the negative predictive value was 100%. When CDI drug therapy was included with the ICD-9-CM code, the sensitivity ranged from 58.1% to 85.5%, specificity was virtually unchanged, and the range in positive predictive value was 37.9%–80.0%.

Conclusion.

Combining the ICD-9-CM code for CDI with drug therapy information increased the positive predictive value for nosocomial CDI but decreased the sensitivity.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 11 , November 2009 , pp. 1070 - 1076
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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