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Validation of hospital discharge coding for neonatal abstinence syndrome
Author(s) -
Yam Patricia,
Lok Laverne,
Eastwood John,
Maher Catherine,
Ward Meredith,
Clews Sara,
Falconer Janet,
Oei Ju Lee
Publication year - 2019
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14803
Subject(s) - medicine , predictive value , confidence interval , abstinence , pediatrics , retrospective cohort study , opioid , psychiatry , receptor
Abstract Aim To validate the diagnostic discharge coding of neonatal abstinence syndrome (NAS) (International Classification of Diseases [ICD]‐10‐AM, P96.1). Methods Retrospective record review of infants diagnosed with NAS (P96.1) in a non‐tertiary Australian hospital between 2000 and 2016. NAS criteria were predetermined to include the following: (i) maternal opioid use; (ii) infant requiring NAS medication and (iii) at least one score of ≥8 on the Finnegan Neonatal Abstinence Scoring Tool (FNAST). Results Of the 253 infants coded with P96.1, 82/146 (56%) opioid‐exposed infants and 9/107(18%) infants exposed to non‐opioid drugs only received withdrawal medication: sensitivity 56.2 (95% confidence interval: 47.7–64.3), specificity 91.6 (84.2–95.8%), positive predictive value (PPV) 90.1 (81.6–95.1%) and negative predictive value (NPV) 60.5 (52.5–68.0%) for all three criteria. Using the criterion of ≥1 FNAST score ≥8 resulted in 58.0 (51.3–64.4%) sensitivity, 63.6 (40.8–82.0%) specificity, 94.4 (88.8–97.4%) PPV and 12.6 (7.3–20.6%) NPV for identifying need for NAS medications. Conclusion A diagnosis of P96.1 is highly specific and predictive but poorly sensitive for identifying opioid‐exposed infants requiring medications for withdrawal.