Electronic Algorithm Is Superior to Hospital Discharge Codes for Diagnoses of Hypertensive Disorders of Pregnancy in Historical Cohorts

Abstract

Objective: To develop and validate criteria for the retrospective diagnoses of hypertensive disorders of pregnancy that would be amenable to the development of an electronic algorithm, and to compare the accuracy of diagnoses based on both the algorithm and diagnostic codes against the gold standard, i.e., physician-made diagnosis. Patients and Methods: An algorithm for hypertensive disorders of pregnancy was developed by first defining a set of criteria for retrospective diagnoses, which included relevant clinical variables and diagnosis of hypertension that required blood pressure elevations in greater than 50 % of readings (“the 50% rule”). The algorithm was validated using the Rochester Epidemiology Project (Rochester, MN, USA). A stratified-random sample of pregnancies and deliveries between January 1, 1976 and December 31, 1982 according to the algorithm-based diagnoses was generated for review and physician-made diagnoses (normotensive, gestational hypertension, and preeclampsia), which served as the gold standard; the targeted cohort for analysis was 25 per diagnosis category based on the gold standard. The agreements between i) the algorithm-based diagnoses and ii) diagnostic codes and the gold standard were analyzed. Results: Sensitivities of the algorithm for 25 normotensive, 25 gestational hypertension, and 25 preeclamptic pregnancies were 100%, 88%, and 100%, respectively. Specificities were 94%, 100%, and 100%, respectively. Diagnostic code sensitivities were 96% for normotensive, 32% for gestational hypertension and 96% for preeclampsia. Specificities were 78%, 96%, and 88%, respectively. Conclusion: Electronic diagnostic algorithm was highly sensitive and specific in identifying and classifying hypertensive disorders of pregnancy and was superior to diagnostic codes.

Serum lncRNAs in early pregnancy as potential biomarkers for the prediction of pregnancy-induced hypertension, including preeclampsia

“…The diagnoses of GH and PE were recognized by an evaluation of the medical records of all included women. 38 GH is defined as SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg or more or both, measured twice at least 4 h apart after 20 weeks of gestation, in a woman with an antecedent normal BP. Like GH, PE is a pregnancy-specific disorder, often with new-onset proteinuria (>300 mg/d or at least +1 on sterile urine dipstick) or other maternal symptoms (cardiovascular, liver, kidney, or hematologic dysfunctions), according to the American College of Obstetricians and Gynecology criteria.…”

Cohort profile: the Olmsted County hypertensive disorders of pregnancy (HDP) cohort using the Rochester Epidemiology Project

“…The Rochester Epidemiology Project (REP) medical records-linkage system is an established institutional resource that has been described in detail elsewhere. 42 44–46 In summary, the REP was created in 1966 and captures healthcare information for the entire population of Olmsted County, Minnesota, USA by linking medical records from multiple healthcare institutions. This database is comprehensive, with only 2% of Olmsted County residents having denied access to their medical records for research purposes.…”

“…We have developed an algorithm that is comparable in sensitivity and specificity to HDP diagnoses based on detailed chart review by trained experts using accepted clinical criteria, which will enable large epidemiological studies of HDP. 42 …”

Identifying Women With a History of a Hypertensive Disorder of Pregnancy: Values, Challenges, and Opportunities

“…In this issue of Mayo Clinic Proceedings, Milic et al 9 introduce an algorithm developed in the Rochester Epidemiology Project using data abstracted from electronic medical records (eg, blood pressures, laboratory test results, symptoms, medications) to retrospectively identify women with a history of HDP. The authors derived 11 detailed HDP definitions ranging from normotension to definitive eclampsia, and the algorithm was built to assign women to one of the HDP diagnoses.…”

“…In conclusion, the utility of an electronic algorithm for identifying women with a history of HDP will only continue to expand as electronic health records are more widely adopted. The novel algorithm by Milic et al 9 has the potential to open new avenues for research on HDP and future health. Although an algorithm-based approach still requires access to electronic medical record data, it has the potential to save time and money without sacrificing data quality.…”