Identifying Pediatric Community-Acquired Pneumonia Hospitalizations

Abstract

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.

Comparative Effectiveness of Empiric Antibiotics for Community-Acquired Pneumonia

“…A random subset of discharges was selected formedical record reviewto verify the diagnosis of CAP as previously described (n = 785). 9 The medical records of children meeting the following definition of CAP were then reviewed to obtain data on presenting signs and symptoms, results of laboratory and radiologic studies, and hospital course: (1) provider diagnosis of pneumonia within the first 48 hours of hospitalization (mention of suspected CAP along with consistent management strategy), (2) fever within first 48 hours of admission or abnormal white blood cell (WBC) count, (3) evidence of respiratory illness (eg, cough or increased work of breathing), and (4) chest radiograph indicating pneumonia (eg, infiltrate or consolidation).…”

Comparative Effectiveness of Empiric Antibiotics for Community-Acquired Pneumonia

“…9 We used the Pediatric Health Information System (PHIS; Children' s Hospital Association, Overland Park, KS) to identify children discharged with a diagnosis of CAP from 4 freestanding children' s hospitals (Monroe Carell Jr Children' s Hospital at Vanderbilt, Nashville, TN; Children' s Mercy Hospitals and Clinics, Kansas City, MO; Seattle Children' s Hospital, Seattle, WA; and Cincinnati Children' s Hospital Medical Center, Cincinnati, OH). The institutional review board at each hospital approved the study.…”

Narrow Vs Broad-spectrum Antimicrobial Therapy for Children Hospitalized With Pneumonia

“…16 The lower age limit sought to minimize the inclusion of children with ,2 doses of routine childhood immunizations (including Haemophilus influenzae and Streptococcus pneumoniae). Because there are no validated disease severity measures for childhood CAP, several design restrictions were created to minimize concerns regarding confounding by severity.…”