title: A systematic review of validated methods to capture acute bronchospasm using administrative or claims data.
abstract: OBJECTIVE
  To identify and assess billing, procedural, or diagnosis code, or pharmacy claim-based algorithms used to identify acute bronchospasm in administrative and claims databases.
  
  
  METHODS
  We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to bronchospasm, wheeze and acute asthma. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics.
  
  
  RESULTS
  Our searches identified 677 citations of which 38 met our inclusion criteria. In these 38 studies, the most commonly used ICD-9 code was 493.x. Only 3 studies reported any validation methods for the identification of bronchospasm, wheeze or acute asthma in administrative and claims databases; all were among pediatric populations and only 2 offered any validation statistics. Some of the outcome definitions utilized were heterogeneous and included other disease based diagnoses, such as bronchiolitis and pneumonia, which are typically of an infectious etiology. One study offered the validation of algorithms utilizing Emergency Department triage chief complaint codes to diagnose acute asthma exacerbations with ICD-9 786.07 (wheezing) revealing the highest sensitivity (56%), specificity (97%), PPV (93.5%) and NPV (76%).
  
  
  CONCLUSIONS
  There is a paucity of studies reporting rigorous methods to validate algorithms for the identification of bronchospasm in administrative data. The scant validated data available are limited in their generalizability to broad-based populations.
authors: Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA. Electronic address: mona.sharifi@childrens.harvard.edu.
authors: Mona
authors: M
authors: Sharifi
authors: Vanderbilt Evidence-based Practice Center, Vanderbilt University Medical Center, 2525 West End Avenue, Ste 600, Nashville, TN 37203, USA. Electronic address: shanthi.krishnaswami@vanderbilt.edu.
authors: Shanthi
authors: S
authors: Krishanswami
authors: Vanderbilt Evidence-based Practice Center, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 2525 West End Avenue, Ste 600, Nashville, TN 37203, USA. Electronic address: melissa.mcpheeters@vanderbilt.edu.
authors: Melissa L
authors: ML
authors: McPheeters
mesh_terms: D000465:Algorithms; D001986:Bronchial Spasm / Q000453:epidemiology*; D016208:Databases, Factual / Q000706:statistics & numerical data*; D004812:Epidemiologic Methods; D006801:Humans; D015994:Incidence; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D038801:International Classification of Diseases / Q000706:statistics & numerical data*
keywords: ARD; Acute asthma; Administrative database; Bronchospasm; ED; HMO; Health Maintenance Organization; ICD-9; LRI; NPV; NR; PPV; Positive predictive value; Se; Sp; WARI; WLRD; Wheeze; acute respiratory disease; emergency department; lower respiratory infection; negative predictive value; not reported; positive predictive value; sensitivity; specificity; wheezing associated respiratory illness; wheezing lower respiratory diseases