title: Accuracy of hospital administrative data in reporting central line-associated bloodstream infections in newborns.
abstract: OBJECTIVE
  Central line-associated bloodstream infections (CLABSIs) are a significant source of morbidity and mortality in the NICU. In 2010, Medicaid was mandated not to pay hospitals for treatment of CLABSI; however, the source of CLABSI data for this policy was not specified. Our objective was to evaluate the accuracy of hospital administrative data compared with CLABSI confirmed by an infection control service.
  
  
  METHODS
  We evaluated hospital administrative and infection control data for newborns admitted consecutively from January 1, 2008, to December 31, 2010. Clinical and demographic data were collected through chart review. We compared cases of CLABSI identified by administrative data (International Classification of Diseases, Ninth Revision, Clinical Modification 999.31) with infection control data that use national criteria from the Centers for Disease Control and Prevention as the gold standard. To ascertain the nature possible deficiencies in the administrative data, each patient's medical record was searched to determine if clinical phrases that commonly refer to CLABSI appeared.
  
  
  RESULTS
  Of 2920 infants admitted to the NICU during our study period, 52 were identified as having a CLABSI: 42 by infection control data only, 7 through hospital administrative data only, and 3 appearing in both. Against the gold standard, hospital administrative data were 6.7% sensitive and 99.7% specific, with a positive predictive value of 30.0% and a negative predictive value of 98.6%. Only 48% of medical records indicated a CLABSI.
  
  
  CONCLUSIONS
  Our findings from a major children's hospital NICU indicate that International Classification of Diseases, Ninth Revision, Clinical Modification code 993.31 is presently not accurate and cannot be used reliably to compare CLABSI rates in NICUs.
authors: Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan, USA. stepatri@med.umich.edu
authors: Stephen W
authors: SW
authors: Patrick
authors: Matthew M
authors: MM
authors: Davis
authors: Aileen B
authors: AB
authors: Sedman
authors: Jennifer A
authors: JA
authors: Meddings
authors: Sue
authors: S
authors: Hieber
authors: Grace M
authors: GM
authors: Lee
authors: Terri L
authors: TL
authors: Stillwell
authors: Carol E
authors: CE
authors: Chenoweth
authors: Claudia
authors: C
authors: Espinosa
authors: Robert E
authors: RE
authors: Schumacher
mesh_terms: D016470:Bacteremia / Q000453:epidemiology*; D055499:Catheter-Related Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D038801:International Classification of Diseases; D008297:Male; D008485:Medical Audit; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014481:United States