Accuracy of Hospital Administrative Data in Reporting Central Line–Associated Bloodstream Infections in Newborns

Abstract

OBJECTIVES: Central line-associated bloodstream infections (CLABSIs) are a significant source of morbidity and mortality in the NICU. In 2010, Medicaid was mandated not to pay hospitals for treatment of CLABSI; however, the source of CLABSI data for this policy was not specified. Our objective was to evaluate the accuracy of hospital administrative data compared with CLABSI confirmed by an infection control service. METHODS:We evaluated hospital administrative and infection control data for newborns admitted consecutively from January 1, 2008, to December 31, 2010. Clinical and demographic data were collected through chart review. We compared cases of CLABSI identified by administrative data (International Classification of Diseases, Ninth Revision, Clinical Modification 999.31) with infection control data that use national criteria from the Centers for Disease Control and Prevention as the gold standard. To ascertain the nature possible deficiencies in the administrative data, each patient' s medical record was searched to determine if clinical phrases that commonly refer to CLABSI appeared. RESULTS:Of 2920 infants admitted to the NICU during our study period, 52 were identified as having a CLABSI: 42 by infection control data only, 7 through hospital administrative data only, and 3 appearing in both. Against the gold standard, hospital administrative data were 6.7% sensitive and 99.7% specific, with a positive predictive value of 30.0% and a negative predictive value of 98.6%. Only 48% of medical records indicated a CLABSI.

Health Care-Associated Infections Among Critically Ill Children in the US, 2007–2012

“…36 Nonetheless, NHSN surveillance data are currently the best available data source for evaluating rates of device-associated infections in the United States, in comparison with alternative data sources, such as hospital billing data. 37,38 Third, the number of hospitals reporting during our study period increased over time, which may affect the interpretation of our findings if the composition of these institutions differed in characteristics that affect rates of HAIs. However, when we restricted the analysis to hospitals that consistently reported during the study period, our findings were similar.…”

Attributable Cost and Length of Stay for Central Line-Associated Bloodstream Infections

“…One study suggests this may be particularly important with estimates of neonatal CLABSI rate. 25 We limited the number of controls that were matched to each discharge case with a CLABSI to 2 to maximize the percentage of CLABSI cases matched to non-CLABSI controls. The 19 cases that were unmatched are mostly associated with very high risk for CLABSI and very high costs and LOS (data not shown).…”

Administrative Data Misclassifies and Fails to Identify Nephrotoxin-Associated Acute Kidney Injury in Hospitalized Children

“…14 However, administrative data are also subject to limitations, such as an inherent inaccuracy of ICD-9 codes relative to clinical diagnoses. [19][20][21][22][23] Administrative data has been used to identify CKD and AKI in adult populations. For CKD, sensitivities showed a high degree of variation, with a median of 41%.…”

“…[19][20][21][22][23] Studying nephrotoxin-associated AKI in noncritically ill hospitalized children using administrative data has not been attempted. This is likely because of the absence of laboratory or patient urine output data, which are key to accurate diagnosis of AKI.…”