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Whose Benchmark Is Right? Validating Venous Thromboembolism Events Between Trauma Registries and Hospital Administrative Databases - 25/04/19

Doi : 10.1016/j.jamcollsurg.2019.02.037 
Todd A. Miano, PharmD, MSCE, FCCM a, b, c, , Grigor Abelian, PharmD e, Mark J. Seamon, MD, FACS d, Kristen Chreiman, MSN, RN, CCRN, TCRN d, Patrick M. Reilly, MD, FACS d, Niels D. Martin, MD, FACS, FCCM d
a Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 
b Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 
c Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 
d Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 
e Department of Clinical Pharmacology and Pharmacometrics, Bristol-Myers Squibb, Philadelphia, PA 

Correspondence address: Todd A Miano, PharmD, MSCE, FCCM, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Dr, 110 Blockley Hall, Philadelphia, PA 19104.Center for Pharmacoepidemiology Research and TrainingPerelman School of Medicine at the University of Pennsylvania423 Guardian Dr110 Blockley HallPhiladelphiaPA19104

Abstract

Background

Venous thromboembolism (VTE) events are tracked in trauma registries and by administrative data sets. Both databases are used to assess outcomes, despite having varying processes for data capture.

Study Design

This study was performed at an urban, university-based, Level I trauma center from 2004 to 2014. Retrospective review of the trauma registry and the hospital’s administrative database was performed querying for all VTEs. Each VTE was then validated through manual chart review. Confirmed events were those with radiographic evidence of VTE by ultrasound, CT, and/or ventilation-perfusion scan. Sensitivity, specificity, and predictive values were calculated and compared between databases.

Results

There were 19,353 trauma patients admitted during the study period; 656 VTEs were identified in the registry and 890 were identified via administrative data; 527 potential events were identified by both databases; 129 events were only in registry; and 363 were only found in the administrative database. We confirmed 636 of 656 events in registry (positive predictive value, 97%; 95% CI, 95.6% to 98.3%) vs 815 of 890 events in administrative data (positive predictive value, 91.6%; 95% CI, 89.75% to 93.4%; p < 0.001). Sensitivity was higher for administrative (87.2% vs 68.0%; p < 0.001), as 299 confirmed VTE events were not in the registry. Differences between the 2 databases were diminished when the analysis excluded untreated events and those present on admission. Twenty-three percent of validated deep vein thrombosis events in the registry were upper extremity events.

Conclusions

The trauma registry showed higher specificity and lower sensitivity compared with administrative data. The low false-positive rate of the trauma registry supports its validity in VTE outcomes research. Additional investigation is needed to evaluate the relevance of the variable sensitivity, likely due to definitional differences. Supplementation of trauma registry data with administrative data can strengthen its completeness.

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 Disclosure Information: Dr Abelian is employed by Bristol-Myers Squibb. All other authors have nothing to disclose.
 Disclosure outside the scope of this work: Dr Seamon received book royalties from Wolters Kluwer Health.
 Support: This work was supported by grants from the NIH (grants F32HL124914 and T32GM075766 to Dr Miano).
 Disclaimer: The NIH had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.


© 2019  American College of Surgeons. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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