Tuesday, January 22, 2013


A systematic review of validation studies of the use of administrative data to identify serious infections.

A systematic review of validation studies of the use of administrative data to identify serious infections.

Jan 2013


Formerly a the Division of Rheumatology, Department of Medicine, University Health Network, and the Division of Health Care and Outcome Research, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Calgary. cehbarbe@ucalgaryca.



To conduct a systematic review of the literature on the validation of algorithms identifying infections in administrative data for future use in populations with rheumatic diseases.


Medline and Embase were searched using the themes "administrative data" and "infection", between 1950 to October 2012. Inclusion criteria: validation studies of administrative data identifying infections in adult populations. Article quality was assessed using a validated tool.


5941 articles were identified, 90 articles underwent detailed review and 24 studies were included. The majority (17/24) examined bacterial infections and nine examined opportunistic infections. Eighteen studies were from the United States and all but four studies used ICD-9 codes. Rheumatoid arthritis patients were studied in 6/24. The studies on bacterial infections in general reported highly variable sensitivity and PPV for the diagnosis of infections using administrative data (sensitivity range 4.4-100%, PPV range 21.7-100%). Algorithms to identify opportunistic infections similarly had a highly variable sensitivity (range 20-100%) and PPV (1.3-99%). Thirteen studies compared the diagnostic accuracy of different algorithms which revealed that strategies including comprehensive algorithm using a greater number of diagnostic codes or codes in any position had the highest sensitivity for the diagnosis of infection. Algorithms which incorporated microbiologic or pharmacy data in combination with diagnostic codes had improved PPV for identification of tuberculosis.


Algorithms for identifying infections using administrative data should be selected based on the purpose of the study with careful consideration as to whether a high sensitivity or PPV is required.


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