Accuracy of Obstetric Diagnoses and Procedures in Hospital Discharge Data

Department of Obstetrics and Gynecology, University of California, Davis, Davis, California, United States
American journal of obstetrics and gynecology (Impact Factor: 4.7). 05/2006; 194(4):992-1001. DOI: 10.1016/j.ajog.2005.08.058
Source: PubMed


The objective of the study was to estimate the validity of obstetric procedures and diagnoses in California patient discharge data.
We randomly sampled 1611 deliveries from 52 of 267 California hospitals that performed more than 678 eligible deliveries in 1992 to 1993. We compared hospital-reported procedures and diagnoses against our recoding of the same records.
Cesarean, forceps, and vacuum delivery were accurately reported, with sensitivities and positive predictive values exceeding 90%. Episiotomy was underreported (70% sensitivity). Cesarean indications were reported with at least 60% sensitivity, except uterine inertia, herpes, and long labor. Among comorbidities, sensitivity exceeded 60% for chorioamnionitis, diabetes, premature labor, preeclampsia, and intrauterine death. Sensitivity was poor (less than 60%) for anemia, asthma, thyroid disorders, mental disorders, drug abuse, genitourinary infections, obesity, fibroids, excessive fetal growth, hypertension, premature rupture, polyhydramnios, and postdates.
The validity of hospital-reported obstetric procedures and diagnoses varies, with moderate to high accuracy for some codes but poor accuracy for others.

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    • "Discharge databases are also open to questions regarding the accuracy of coding. Yasmeen et al. recently assessed the accuracy and reliability of obstetric discharge databases and found them to provide helpful information [16]. Thus, despite the limitations of the NIS database, the study design allows the examination or relatively rare disorders using a large numbers of pregnancies. "
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    ABSTRACT: Objective: Pyelonephritis is a common cause of antepartum admission and maternal morbidity. Medical complications associated with pyelonephritis during delivery are not well described; thus the objective of this study was to estimate medical, infectious, and obstetric complications associated with pyelonephritis during the delivery admission. Study design: We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) for the years 2008-2010. The NIS was queried for all delivery-related discharges. During the delivery admission, the ICD-9-CM codes for pyelonephritis were used to identify cases and were compared to women without pyelonephritis. A multivariable logistic regression model was constructed for various medical, infectious, and obstetric complications among women with pyelonephritis compared to women without, while controlling for preexisting medical conditions and demographics. Results: During the years 2008-2010, there were 26,397 records with a diagnosis of pyelonephritis during the delivery admission, for a rate of 2.1 per 1000 deliveries. Women with pyelonephritis had increased associated risks for transfusion, need for mechanical ventilation, acute heart failure, pneumonia, pulmonary edema, acute respiratory distress syndrome, sepsis, acute renal failure, preterm labor, and chorioamnionitis, while controlling for preexisting medical conditions. Conclusions: Pyelonephritis at delivery admissions is associated with significant medical and infectious morbidity.
    Infectious Diseases in Obstetrics and Gynecology 09/2013; 2013(1):124102. DOI:10.1155/2013/124102
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    • "We are not aware of any studies that have specifically validated “method of delivery” coding in HES against hospital records, but studies of similar administrative health databases in other countries have reported high levels of agreement (kappa > 0.98, where stated) [18-21]. "
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    ABSTRACT: Background Information on maternity services is increasingly derived from national administrative health data. We evaluated how statistics on maternity care in England were affected by the completeness and consistency of data on “method of delivery” in a national dataset. Methods Singleton deliveries occurring between April 2009 and March 2010 in English NHS trusts were extracted from the Hospital Episode Statistics (HES) database. In HES, method of delivery can be entered twice: 1) as a procedure code in core fields, and 2) in supplementary maternity fields. We examined overall consistency of these data sources at a national level and among individual trusts. The impact of different analysis rules for handling inconsistent data was then examined using three maternity statistics: emergency caesarean section (CS) rate; third/fourth degree tear rate amongst instrumental deliveries, and elective CS rate for breech presentation. Results We identified 629,049 singleton deliveries. Method of delivery was not entered as a procedure or in the supplementary fields in 0.8% and 12.5% of records, respectively. In 545,594 records containing both data items, method of delivery was coded consistently in 96.3% (kappa = 0.93; p < 0.001). Eleven of 136 NHS trusts had comparatively poor consistency (<92%) suggesting systematic data entry errors. The different analysis rules had a small effect on the statistics at a national level but the effect could be substantial for individual NHS trusts. The elective CS rate for breech was most sensitive to the chosen analysis rule. Conclusions Organisational maternity statistics are sensitive to inconsistencies in data on method of delivery, and publications of quality indicators should describe how such data were handled. Overall, method of delivery is coded consistently in English administrative health data.
    BMC Health Services Research 05/2013; 13(1):200. DOI:10.1186/1472-6963-13-200 · 1.71 Impact Factor
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    • "The coding of the diagnoses and procedures in administrative databases is potentially inaccurate. However, this is unlikely to have had a major effect in our study because previous studies have reported high-levels of agreement in the coding of cesarean section between administrative databases and medical reviews (kappa > 0.98, where stated) [66-68]. Furthermore, cesarean deliveries were defined using the first three characters of the full 4-character OPCS codes, and broader categories rather than specific codes have been shown to be more reliable[69]. "
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    ABSTRACT: Objective: To compare the risk of placenta previa at second birth among women who had a cesarean section (CS) at first birth with women who delivered vaginally. Retrospective cohort study of 399,674 women who gave birth to a singleton first and second baby between April 2000 and February 2009 in England. Multiple logistic regression was used to adjust the estimates for maternal age, ethnicity, deprivation, placenta previa at first birth, inter-birth interval and pregnancy complications. In addition, we conducted a meta-analysis of the reported results in peer-reviewed articles since 1980. The rate of placenta previa at second birth for women with vaginal first births was 4.4 per 1000 births, compared to 8.7 per 1000 births for women with CS at first birth. After adjustment, CS at first birth remained associated with an increased risk of placenta previa (odds ratio = 1.60; 95% CI 1.44 to 1.76). In the meta-analysis of 37 previously published studies from 21 countries, the overall pooled random effects odds ratio was 2.20 (95% CI 1.96-2.46). Our results from the current study is consistent with those of the meta-analysis as the pooled odds ratio for the six population-based cohort studies that analyzed second births only was 1.51 (95% CI 1.39-1.65). There is an increased risk of placenta previa in the subsequent pregnancy after CS delivery at first birth, but the risk is lower than previously estimated. Given the placenta previa rate in England and the adjusted effect of previous CS, 359 deliveries by CS at first birth would result in one additional case of placenta previa in the next pregnancy.
    BMC Pregnancy and Childbirth 11/2011; 11(1):95. DOI:10.1186/1471-2393-11-95 · 2.19 Impact Factor
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