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. 2017 Feb 15;12(2):e0171266.
doi: 10.1371/journal.pone.0171266. eCollection 2017.

Hospital discharge abstracts have limited accuracy in identifying occurrence of Clostridium difficile infections among hospitalized individuals with inflammatory bowel disease: A population-based study

Harminder Singh  1   2   3 , Zoann Nugent  1   2   4 , B Nancy Yu  3   5 , Lisa M Lix  3 , Laura Targownik  1   2 , Charles Bernstein  1   2
Affiliations

Hospital discharge abstracts have limited accuracy in identifying occurrence of Clostridium difficile infections among hospitalized individuals with inflammatory bowel disease: A population-based study

Harminder Singh et al. PLoS One. .

Abstract

Background: Hospital discharge databases are used to study the epidemiology of Clostridium difficile infections (CDI) among hospitalized patients with inflammatory bowel disease (IBD). CDI in IBD is increasingly important and accurately estimating its occurrence is critical in understanding its comorbidity. There are limited data on the reliability of the International Classification of Diseases 10th revision (ICD-10) (now widely used in North America) CDI code in determining occurrence of CDI among hospitalized patients. We compared the performance of ICD-10 CDI coding to laboratory confirmed CDI diagnoses.

Methods: The University of Manitoba IBD Epidemiology Database was used to identify individuals with and without IBD discharged with CDI diagnoses between 07/01/2005 and 3/31/2014. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ICD-10 CDI code was compared to laboratory CDI diagnoses recorded in a province wide CDI dataset. Multivariable logistic regression models were performed to test the predictors of diagnostic inaccuracy of ICD-10 CDI code.

Results: There were 273 episodes of laboratory confirmed CDI (hospitalized and non-hospitalized) among 7396 individuals with IBD and 536 among 66,297 matched controls. The sensitivity, specificity, PPV and NPV of ICD-10 CDI code in discharge abstracts was 72.8%, 99.6%, 64.1% and 99.7% among those with IBD and 70.8%, 99.9%, 79.0% and 99.9% among those without IBD. Predictors of diagnostic inaccuracy included IBD, older age, increased co-morbidity and earlier years of hospitalization.

Conclusions: Identification of CDI using ICD-10 CDI code in hospital discharge abstracts may not identify up to 30% of CDI cases, with worse performance among those with IBD.

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Conflict of interest statement

Competing Interests: Dr. Singh has been on advisory board of Pendopharm and Ferring Canada and has received research funding from Merck Canada. Dr. Bernstein is supported in part by the Bingham Chair in Gastroenterology. He has served on advisory boards for Abbvie Canada, Ferring Canada, Janssen Canada, Shire Canada, Pfizer Canada and Takeda Canada. He has consulted to Mylan Pharmaceuticals and Bristol Myers Squibb. He has received unrestricted educational grants from Abbvie Canada, Janssen Canada, Shire Canada, and Takeda Canada. He has been on speaker’s bureau for Abbvie Canada and Shire Canada. Dr. Targownik: Speaker’s Panel for Janssen Canada, Takeda Canada, Pfizer Canada; Grant Support from Pfizer Canada and Abbvie Canada; Advisory Boards for Pfizer Canada, Takeda Canada, Abbvie Canada, Janssen Canada. Dr. Lix is supported by a Research Manitoba Chair. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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