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Medical chart validation of inpatient diagnosis codes for transfusion‐related acute lung injury 2013‐2015
Author(s) -
Fuller Candace C.,
Nambudiri Vinod E.,
SpencerSmith Caren,
Curtis Lesley H.,
Shinde Mayura,
Cosgrove Austin,
Johnson Margaret,
Hickok Jason,
Honda Stacey,
Ismail Heba,
Kaufman Richard Max,
Kennedy Adee,
Miller Karla M.,
Mohlman David J.,
Poland Russell E.,
Rosofsky Robert,
Smith Kimberly,
Surani Salim R.,
Baker Meghan A.
Publication year - 2021
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.16251
Subject(s) - transfusion related acute lung injury , medicine , emergency medicine , chart , diagnosis code , intensive care medicine , blood transfusion , lung , population , statistics , mathematics , environmental health , pulmonary edema
Transfusion‐related acute lung injury (TRALI), an adverse event occurring during or within 6 hours of transfusion, is a leading cause of transfusion‐associated fatalities reported to the US Food and Drug Administration. There is limited information on the validity of diagnosis codes for TRALI recorded in inpatient electronic medical records (EMRs). Study Designs and Methods We conducted a validation study to establish the positive predictive value (PPV) of TRALI International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) diagnosis codes recorded within a large hospital system between 2013 and 2015. A physician with critical care expertise confirmed the TRALI diagnosis. As TRALI is likely underdiagnosed, we used the specific code (518.7), and codes for respiratory failure (518.82) in combination with transfusion reaction (999.80, 999.89, E934.7). Results Among almost four million inpatient stays, we identified 208 potential TRALI cases with ICD‐9‐CM codes and reviewed 195 medical records; 68 (35%) met clinical definitions for TRALI (26 [38%] definitive, 15 [22%] possible, 27 [40%] delayed). Overall, the PPV for all inpatient TRALI diagnoses was 35% (95% confidence interval (CI), 28‐42). The PPV for the TRALI‐specific code was 44% (95% CI, 35‐54). Conclusion We observed low PPVs (<50%) for TRALI ICD‐9‐CM diagnosis codes as validated by medical charts, which may relate to inconsistent code use, incomplete medical records, or other factors. Future studies using TRALI diagnosis codes in EMR databases may consider confirming diagnoses with medical records, assessing TRALI ICD, Tenth Revision, Clinical Modification codes, or exploring alternative ways for of accurately identifying TRALI in EMR databases. Key Points In 169 hospitals, we identified 208 potential TRALI cases, reviewed 195 charts, and confirmed 68 (35%) cases met TRALI clinical definitions. As many potential TRALI cases identified with diagnosis codes did not meet clinical definitions, medical record confirmation may be prudent.