Validity and Reliability of Administrative Coded Data for the Identification of Hospital-Acquired Infections: An Updated Systematic Review with Meta-Analysis and Meta-Regression Analysis
Por:
Redondo-González O, Tenías JM, Arias Á and Lucendo AJ
Publicada:
1 jun 2018
Categoría:
Health policy
Resumen:
ObjectiveTo conduct an updated assessment of the validity and
reliability of administrative coded data (ACD) in identifying
hospital-acquired infections (HAIs).
MethodsWe systematically searched three libraries for studies on ACD
detecting HAIs compared to manual chart review. Meta-analyses were
conducted for prosthetic and nonprosthetic surgical site infections
(SSIs), Clostridium difficile infections (CDIs), ventilator-associated
pneumonias/events (VAPs/VAEs) and non-VAPs/VAEs, catheter-associated
urinary tract infections (CAUTIs), and central venous catheter-related
bloodstream infections (CLABSIs). A random-effects meta-regression model
was constructed.
ResultsOf 1,906 references found, we retrieved 38 documents, of which 33
provided meta-analyzable data (N=567,826 patients). ACD identified HAI
incidence with high specificity (93 percent), prosthetic SSIs with high
sensitivity (95 percent), and both CDIs and nonprosthetic SSIs with
moderate sensitivity (65 percent). ACD exhibited substantial agreement
with traditional surveillance methods for CDI (=0.70) and provided
strong diagnostic odds ratios (DORs) for the identification of CDIs
(DOR=772.07) and SSIs (DOR=78.20). ACD performance in identifying
nosocomial pneumonia depended on the ICD coding system
(DORICD-10/ICD-9-CM=0.05; p=.036). Algorithmic coding improved ACD's
sensitivity for SSIs up to 22 percent. Overall, high heterogeneity was
observed, without significant publication bias.
ConclusionsAdministrative coded data may not be sufficiently accurate or
reliable for the majority of HAIs. Still, subgrouping and algorithmic
coding as tools for improving ACD validity deserve further
investigation, specifically for prosthetic SSIs. Analyzing a potential
lower discriminative ability of ICD-10 coding system is also a pending
issue.
Filiaciones:
Redondo-González O:
Research Support Unit, Hospital General La Mancha Centro, Ciudad Real, Spain
:
Preventive Medicine Unit, Pare Jofré Hospital, Valencia, Spain
Arias Á:
Research Support Unit, Hospital General La Mancha Centro, Ciudad Real, Spain
Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
Lucendo AJ:
Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
Department of Gastroenterology, Hospital General de Tomelloso, Ciudad Real, Spain
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