title: Validation of a computer case definition for sudden cardiac death in opioid users.
abstract: BACKGROUND
  To facilitate the use of automated databases for studies of sudden cardiac death, we previously developed a computerized case definition that had a positive predictive value between 86% and 88%. However, the definition has not been specifically validated for prescription opioid users, for whom out-of-hospital overdose deaths may be difficult to distinguish from sudden cardiac death.
  
  
  RESULTS
  We assembled a cohort of persons 30-74 years of age prescribed propoxyphene or hydrocodone who had no life-threatening non-cardiovascular illness, diagnosed drug abuse, residence in a nursing home in the past year, or hospital stay within the past 30 days. Medical records were sought for a sample of 140 cohort deaths within 30 days of a prescription fill meeting the computer case definition. Of the 140 sampled deaths, 81 were adjudicated; 73 (90%) were sudden cardiac deaths. Two deaths had possible opioid overdose; after removing these two the positive predictive value was 88%.
  
  
  CONCLUSIONS
  These findings are consistent with our previous validation studies and suggest the computer case definition of sudden cardiac death is a useful tool for pharmacoepidemiologic studies of opioid analgesics.
authors.affiliation: Division of Pharmacoepidemiology, Department of Preventive Medicine, Nashville, TN, USA.
authors.forename: Vivian K
authors.initials: VK
authors.lastname: Kawai
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Murray
authors.forename: C Michael
authors.initials: CM
authors.lastname: Stein
authors.forename: William O
authors.initials: WO
authors.lastname: Cooper
authors.forename: David J
authors.initials: DJ
authors.lastname: Graham
authors.forename: Kathi
authors.initials: K
authors.lastname: Hall
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Ray
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D011431:Dextropropoxyphene / Q000009:adverse effects*; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D006801:Humans; D006853:Hydrocodone / Q000009:adverse effects*; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
chemical_list: D000701:Analgesics, Opioid; D006853:Hydrocodone; D011431:Dextropropoxyphene