Importance Community-acquired pneumonia (CAP) remains one of the most common indications for pediatric hospitalization in the United States, and it is frequently the focus of research and quality studies. Use of administrative data is increasingly common for these purposes, although proper validation is required to ensure valid study conclusions. Objective To validate administrative billing data for childhood community-acquired pneumonia (CAP) hospitalizations. Design Case-control. Setting Four freestanding children’s hospitals in the United States. Participants Medical records of a 25% random sample of 3,646 children (n=998) discharged in 2010 with at least one ICD-9-CM code representing possible pneumonia were reviewed. Discharges (matched on date of admission) without a pneumonia-related discharge code were also reviewed to identify potential missed pneumonia cases. Two reference standards, based on provider diagnosis alone (provider-confirmed) or in combination with clinical and radiographic evidence of pneumonia (definite), were used to identify CAP. Main Exposure Twelve ICD-9-CM based coding strategies, each using a combination of primary or secondary codes representing pneumonia or pneumonia-related complications. Six algorithms excluded children with complex chronic conditions. Main Outcome Measures Sensitivity, specificity, negative and positive predictive values (NPV, PPV) of the twelve identification strategies. Results For provider-confirmed CAP (n=680), sensitivity ranged from 60.7–99.7%; specificity 75.7–96.4%; PPV 67.9–89.6%; and NPV 82.6–99.8%. For definite CAP (n=547), sensitivity ranged from 65.6–99.6%; specificity 68.7–93.0%; PPV 54.6–77.9%; and NPV 87.8–99.8%. Unrestricted use of the pneumonia-related codes was inaccurate, although several strategies improved specificity to >90% with variable impact on sensitivity. Excluding children with complex chronic conditions demonstrated the most favorable performance characteristics. Performance of the algorithms was similar across institutions. Conclusions and Relevance Administrative data are valuable for studying pediatric CAP hospitalizations. The strategies presented here will aid in the accurate identification of relevant and comparable patient populations for both research and performance improvement studies.
Medical students frequently experience moral distress. Our survey can be used to measure aspects of the learning environment as well as individual responses to the environment. The variation found among student responses warrants further investigation to determine whether students at either extreme of moral distress are at risk of burnout or erosion of professionalism.
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