Abstract P29: Administrative Data Can Be Used to Decrease Medical Record Review Burden While Maintaining High Sensitivity When Assessing Complex Cardiac Outcomes in Hospitalized Patients
Authors: Stephens Kimberly E , Funk Marjorie , Fennie Kristopher P , May Jeanine L , Herak Al , Makar Ellen V , Rimar Joan , Hillman John M , Winkler Catherine , Diers Donna , Drew Barbara J 
Published: July 2021

Introduction:
Administrative data alone are often inadequate to identify the occurrence of complex clinical outcomes, such as life-threatening arrhythmias (LTA). Although medical record review is more comprehensive, it is resource intensive. Used together, administrative data and medical record review may be an efficient way to obtain valid and reliable outcomes data.

Objective:
To determine if the use of selected ICD-9-CM codes and pharmacy charges may decrease the number of medical records reviewed to identify patients who had a LTA requiring emergency intervention during their hospitalization.

Methods:
The PULSE Trial is a multi-site randomized clinical trial examining patient outcomes, including LTAs. Complete medical record review in 2 of 17 participating hospitals identified all LTAs events (asystole, hemodynamically unstable bradyarrhythmia, sustained ventricular tachycardia, torsades de pointes, ventricular fibrillation) that occurred during 3,049 patient encounters from 2/08 to 8/08. We identified 48 codes potentially associated with LTA from review of the ICD-9-CM and HCPCS (Healthcare Common Procedure Coding System) manuals. These 48 codes and demographic data were obtained from hospital administrative databases. Logistic regression identified 9 independent predictors of LTAs; 5 additional variables were included to achieve maximum sensitivity of our final model.

Results:
Of the 48 codes, 14 codes identified 98.2% of the 54 patient encounters where a LTA had been identified through medical record review (Table). Use of these 14 codes decreases the number of medical records that will need to be reviewed to 22.8% of all 55,000 records for subsequent examination of the occurrence of LTAs.

Conclusion:
Standardized codes from administrative databases can be used to decrease the volume of medical records that need to be reviewed for determining complex patient outcomes, such as LTA in hospitalized patients, while maintaining high sensitivity.

Sensitivity of Administrative Codes in Detecting Occurrences of Life-Threatening Arrhythmias

ICD-9-CM or HCPCS Code
Brief Description
N (%) with Code
N (%) with Code who Had LTA Event

99.6
Cardiopulmonary resuscitation
25 (0.8%)
13 (52.0%)

37.81
Initial insertion of single-chamber pacemaker
4 (0.1%)
2 (50.0%)

37.78
Insertion of temporary transvenous pacemaker
15 (0.5%)
5 (33.3%)

427.5
Cardiac arrest
49 (1.6%)
15 (30.6%)

Discharge disposition
Dead at discharge
109 (3.6%)
20 (18.4%)

37.83
Initial insertion of dual-chamber pacemaker
54 (1.8%)
8 (14.8%)

37.72
Initial insertion of transvenous leads
56 (1.8%)
8 (14.3%)

997.1
Cardiac arrest during or resulting from a procedure
59 (1.9%)
7 (11.9%)

J0460
IV atropine sulfate
60 (2.0%)
7 (11.7%)

37.74
Insert/replace epicardial lead into epicardium
9 (0.3%)
1 (11.1%)

427.1
Paroxysmal ventricular tachycardia
174 (5.7%)
18 (10.3%)

J3475
Intravenous magnesium sulfate
44 (1.4%)
3 (6.8%)

427.89
Other cardiac arrhythmia
206 (6.8%)
14 (6.8%)

J2001
Intravenous lidocaine
118 (3.9%)
6 (5.1%)