title: Cases of iatrogenic pneumothorax can be identified from ICD-9-CM coded data.
abstract: Hospital administrative data are being used to identify hospitals with hospital-acquired complications such as iatrogenic pneumothorax. This was a retrospective cross-sectional study of hospitalization records to estimate the positive predictive value (PPV) of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator for iatrogenic pneumothorax. A probability sample of inpatient medical records from 2006 to 2007 was reviewed in a national sample of 28 volunteer hospitals. Among the 200 flagged cases, the PPV was 78% (95% confidence interval = 73%-82%). False positive cases were mostly a result of exclusionary conditions (11%) and pneumothoraxes that were present on admission (7%). About 44% of events followed attempted central venous catheter (CVC) placement. Of the 69 CVC-associated events, only 5 occurred with ultrasound guidance. AHRQ's iatrogenic pneumothorax indicator can serve in quality of care improvement. At least 1725 hospital-acquired pneumothoraxes could have been prevented in 2004 through universal use of ultrasound guidance during internal jugular cannulation.
authors.affiliation: University of California, Davis, Sacramento, CA 95817, USA. bsadeghi@ucdavis.edu
authors.forename: Banafsheh
authors.initials: B
authors.lastname: Sadeghi
authors.forename: Ruth
authors.initials: R
authors.lastname: Baron
authors.forename: Patricia
authors.initials: P
authors.lastname: Zrelak
authors.forename: Garth H
authors.initials: GH
authors.lastname: Utter
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Geppert
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tancredi
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000706:statistics & numerical data; D015984:Causality; D003430:Cross-Sectional Studies; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D038801:International Classification of Diseases / Q000706:statistics & numerical data*; D008499:Medical Records / Q000706:statistics & numerical data*; D011030:Pneumothorax / Q000145:classification / Q000453:epidemiology* / Q000209:etiology; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D016270:United States Agency for Healthcare Research and Quality