title: Identifying pediatric community-acquired pneumonia hospitalizations: Accuracy of administrative billing codes.
abstract: OBJECTIVE
  Community-acquired pneumonia (CAP) remains one of the most common indications for pediatric hospitalization in the United States, and it is frequently the focus of research and quality studies. Use of administrative data is increasingly common for these purposes, although proper validation is required to ensure valid study conclusions.
  
  
  OBJECTIVE
  To validate administrative billing data for hospitalizations owing to childhood CAP.
  
  
  METHODS
  Case-control study of 4 tertiary care, freestanding children’s hospitals in the United States.
  
  
  METHODS
  A total of 998 medical records of a 25% random sample of 3646 children discharged in 2010 with at least 1 International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code representing possible pneumonia were reviewed. Discharges (matched on date of admission) without a pneumonia-related discharge code were also examined to identify potential missed pneumonia cases. Two reference standards, based on provider diagnosis alone (provider confirmed) or in combination with consistent clinical and radiographic evidence of pneumonia (definite), were used to identify CAP.
  
  
  METHODS
  Twelve ICD-9-CM–based coding strategies, each using a combination of primary or secondary codes representing pneumonia or pneumonia-related complications. Six algorithms excluded children with complex chronic conditions.
  
  
  METHODS
  Sensitivity, specificity, and negative and positive predictive values (NPV and PPV, respectively) of the 12 identification strategies.
  
  
  RESULTS
  For provider-confirmed CAP (n = 680), sensitivity ranged from 60.7% to 99.7%; specificity, 75.7% to 96.4%; PPV, 67.9% to 89.6%; and NPV, 82.6% to 99.8%. For definite CAP (n = 547), sensitivity ranged from 65.6% to 99.6%; specificity, 68.7% to 93.0%; PPV, 54.6% to 77.9%; and NPV, 87.8% to 99.8%. Unrestricted use of the pneumonia-related codes was inaccurate, although several strategies improved specificity to more than 90% with a variable effect on sensitivity. Excluding children with complex chronic conditions demonstrated the most favorable performance characteristics. Performance of the algorithms was similar across institutions.
  
  
  CONCLUSIONS
  Administrative data are valuable for studying pediatric CAP hospitalizations. The strategies presented here will aid in the accurate identification of relevant and comparable patient populations for research and performance improvement studies.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Williams
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Angela
authors.initials: A
authors.lastname: Myers
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.forename: Katherine
authors.initials: K
authors.lastname: Auger
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Queen
authors.forename: Karen E
authors.initials: KE
authors.lastname: Jerardi
authors.forename: Lauren
authors.initials: L
authors.lastname: McClain
authors.forename: Catherine
authors.initials: C
authors.lastname: Wiggleton
authors.forename: Joel S
authors.initials: JS
authors.lastname: Tieder
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D038801:International Classification of Diseases; D008297:Male; D008499:Medical Records / Q000592:standards*; D011014:Pneumonia / Q000175:diagnosis*; D012015:Reference Standards; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers; D014481:United States
references.citation: J Biomed Inform. 2009 Apr;42(2):377-81
references.pmid: 18929686
references.citation: Am J Med Qual. 2005 Nov-Dec;20(6):319-28
references.pmid: 16280395
references.citation: Health Serv Res. 2005 Oct;40(5 Pt 2):1620-39
references.pmid: 16178999
references.citation: Chest. 2012 Jan;141(1):87-93
references.pmid: 21757568
references.citation: PLoS One. 2010 Aug 06;5(8):e11989
references.pmid: 20700510
references.citation: Pediatrics. 2011 Aug;128(2):323-30
references.pmid: 21768320
references.citation: JAMA. 2008 May 7;299(17):2048-55
references.pmid: 18460665
references.citation: J Clin Epidemiol. 2007 Aug;60(8):834-8
references.pmid: 17606180
references.citation: Am J Public Health. 1992 Feb;82(2):243-8
references.pmid: 1739155
references.citation: N Engl J Med. 1988 Feb 11;318(6):352-5
references.pmid: 3123929
references.citation: Jt Comm J Qual Improv. 1995 Dec;21(12):668-82
references.pmid: 8688923
references.citation: Pediatr Radiol. 2009 Apr;39(4):348-53
references.pmid: 19241075
references.citation: JAMA. 2012 Apr 4;307(13):1405-13
references.pmid: 22474204
references.citation: Lancet. 2005 Mar 26-Apr 1;365(9465):1147-52
references.pmid: 15794969
references.citation: Am J Med Qual. 1997 Winter;12(4):187-93
references.pmid: 9385729
references.citation: Pediatrics. 2005 Jan;115(1):135-45
references.pmid: 15579669
references.citation: JAMA. 1997 Dec 17;278(23):2080-4
references.pmid: 9403422
references.citation: Epidemiol Infect. 2008 Feb;136(2):232-40
references.pmid: 17445319
references.citation: Pediatrics. 2001 Jun;107(6):E99
references.pmid: 11389297
references.citation: Surgery. 2011 Nov;150(5):943-9
references.pmid: 21875734
references.citation: Clin Infect Dis. 2011 Oct;53(7):e25-76
references.pmid: 21880587
references.citation: Pediatrics. 2009 Jul;124(1):e29-36
references.pmid: 19564266
references.citation: Med Care. 1987 Jan;25(1):20-4
references.pmid: 3807447
references.citation: Med Care. 2002 Oct;40(10):856-67
references.pmid: 12395020
references.citation: Neurology. 1997 Sep;49(3):660-4
references.pmid: 9305319
references.citation: Arch Pediatr Adolesc Med. 2011 Jun;165(6):506-12
references.pmid: 21300649
references.citation: J Clin Epidemiol. 2011 Oct;64(10):1054-9
references.pmid: 21474278