title: Evaluation of clinical coding data to determine causes of critical bleeding in patients receiving massive transfusion: a bi-national, multicentre, cross-sectional study.
abstract: OBJECTIVE
  To evaluate the use of routinely collected data to determine the cause(s) of critical bleeding in patients who receive massive transfusion (MT).
  
  
  BACKGROUND
  Routinely collected data are increasingly being used to describe and evaluate transfusion practice.
  
  
  METHODS
  Chart reviews were undertaken on 10 randomly selected MT patients at 48 hospitals across Australia and New Zealand to determine the cause(s) of critical bleeding. Diagnosis-related group (DRG) and International Classification of Diseases (ICD) codes were extracted separately and used to assign each patient a cause of critical bleeding. These were compared against chart review using percentage agreement and kappa statistics.
  
  
  RESULTS
  A total of 427 MT patients were included with complete ICD and DRG data for 427 (100%) and 396 (93%), respectively. Good overall agreement was found between chart review and ICD codes (78·3%; κ = 0·74, 95% CI 0·70-0·79) and only fair overall agreement with DRG (51%; κ = 0·45, 95% CI 0·40-0·50). Both ICD and DRG were sensitive and accurate for classifying obstetric haemorrhage patients (98% sensitivity and κ > 0·94). However, compared with the ICD algorithm, DRGs were less sensitive and accurate in classifying bleeding as a result of gastrointestinal haemorrhage (74% vs 8%; κ = 0·75 vs 0·1), trauma (92% vs 62%; κ = 0·78 vs 0·67), cardiac (80% vs 57%; κ = 0·79 vs 0·60) and vascular surgery (64% vs 56%; κ = 0·69 vs 0·65).
  
  
  CONCLUSIONS
  Algorithms using ICD codes can determine the cause of critical bleeding in patients requiring MT with good to excellent agreement with clinical history. DRG are less suitable to determine critical bleeding causes.
authors.affiliation: Transfusion Research Unit, Monash University, Melbourne, Australia.|Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia.
authors.forename: Z K
authors.initials: ZK
authors.lastname: McQuilten
authors.affiliation: Transfusion Research Unit, Monash University, Melbourne, Australia.|Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Zatta
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Andrianopoulos
authors.affiliation: Transfusion Research Unit, Monash University, Melbourne, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Aoki
authors.affiliation: Barwon Health, University Hospital Geelong, Geelong, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Stevenson
authors.affiliation: New Zealand Blood Service, Christchurch, New Zealand.
authors.forename: K G
authors.initials: KG
authors.lastname: Badami
authors.affiliation: Princess Alexandra Hospital, Brisbane, Queensland.|School of Medicine, Griffith University, Brisbane, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Bird
authors.affiliation: Department of Haematology, St Vincent's Hospital, Melbourne, Australia.
authors.forename: M F
authors.initials: MF
authors.lastname: Cole-Sinclair
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: C
authors.identifier: http://orcid.org/0000-0002-6034-170X
authors.initials: C
authors.lastname: Hurn
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: P A
authors.initials: PA
authors.lastname: Cameron
authors.affiliation: Royal North Shore Hospital, The University of Sydney, Sydney, Australia.
authors.forename: J P
authors.initials: JP
authors.lastname: Isbister
authors.affiliation: Transfusion Research Unit, Monash University, Melbourne, Australia.
authors.forename: L E
authors.initials: LE
authors.lastname: Phillips
authors.affiliation: Transfusion Research Unit, Monash University, Melbourne, Australia.
authors.forename: E M
authors.initials: EM
authors.lastname: Wood
mesh_terms: D000328:Adult; D000465:Algorithms; D001315:Australia; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D059019:Clinical Coding; D003430:Cross-Sectional Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D009520:New Zealand; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014947:Wounds and Injuries / Q000145:classification / Q000175:diagnosis / Q000628:therapy
keywords: administrative data; critical bleeding; haemorrhage; massive transfusion; red blood cell transfusion