Use of electronic health record data to identify skin and soft tissue infections in primary care settings: A validation study

Pamela J. Levine, Miriam R. Elman, Ravina Kullar, John Townes, David T. Bearden, Rowena Vilches-Tran, Ian McClellan, Jessina C. McGregor

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Epidemiologic studies of skin and soft tissue infections (SSTIs) depend upon accurate case identification. Our objective was to evaluate the positive predictive value (PPV) of electronic medical record data for identification of SSTIs in a primary care setting.Methods: A validation study was conducted among primary care outpatients in an academic healthcare system. Encounters during four non-consecutive months in 2010 were included if any of the following were present in the electronic health record: International Classification of Diseases, Ninth Revision (ICD-9) code for an SSTI, Current Procedural Terminology (CPT) code for incision and drainage, or a positive wound culture. Detailed chart review was performed to establish presence and type of SSTI. PPVs and 95% confidence intervals (CI) were calculated among all encounters, initial encounters, and cellulitis/abscess cases.Results: Of the 731 encounters included, 514 (70.3%) were initial encounters and 448 (61.3%) were cellulitis/abscess cases. When the presence of an ICD-9 code, CPT code, or positive culture was used to identify SSTIs, 617 encounters were true positives, yielding a PPV of 84.4% [95% CI: 81.8-87.0%]. The PPV for using ICD-9 codes alone to identify SSTIs was 90.7% [95 % CI: 88.5-92.9%]. For encounters with cellulitis/abscess codes, the PPV was 91.5% [95% CI: 88.9-94.1%].Conclusions: ICD-9 codes may be used to retrospectively identify SSTIs with a high PPV. Broadening SSTI case identification with microbiology data and CPT codes attenuates the PPV. Further work is needed to estimate the sensitivity of this method.

Original languageEnglish (US)
Article number171
JournalBMC Infectious Diseases
Volume13
Issue number1
DOIs
StatePublished - Apr 10 2013

Fingerprint

Soft Tissue Infections
Electronic Health Records
Validation Studies
International Classification of Diseases
Primary Health Care
Skin
Current Procedural Terminology
Cellulitis
Confidence Intervals
Abscess
Microbiology
Epidemiologic Studies
Drainage
Outpatients
Delivery of Health Care

Keywords

  • Abscess
  • Methodologies
  • Positive predictive value
  • Primary care
  • Skin infection

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Use of electronic health record data to identify skin and soft tissue infections in primary care settings : A validation study. / Levine, Pamela J.; Elman, Miriam R.; Kullar, Ravina; Townes, John; Bearden, David T.; Vilches-Tran, Rowena; McClellan, Ian; McGregor, Jessina C.

In: BMC Infectious Diseases, Vol. 13, No. 1, 171, 10.04.2013.

Research output: Contribution to journalArticle

Levine, Pamela J. ; Elman, Miriam R. ; Kullar, Ravina ; Townes, John ; Bearden, David T. ; Vilches-Tran, Rowena ; McClellan, Ian ; McGregor, Jessina C. / Use of electronic health record data to identify skin and soft tissue infections in primary care settings : A validation study. In: BMC Infectious Diseases. 2013 ; Vol. 13, No. 1.
@article{523141ec38204c448b800116815cda60,
title = "Use of electronic health record data to identify skin and soft tissue infections in primary care settings: A validation study",
abstract = "Background: Epidemiologic studies of skin and soft tissue infections (SSTIs) depend upon accurate case identification. Our objective was to evaluate the positive predictive value (PPV) of electronic medical record data for identification of SSTIs in a primary care setting.Methods: A validation study was conducted among primary care outpatients in an academic healthcare system. Encounters during four non-consecutive months in 2010 were included if any of the following were present in the electronic health record: International Classification of Diseases, Ninth Revision (ICD-9) code for an SSTI, Current Procedural Terminology (CPT) code for incision and drainage, or a positive wound culture. Detailed chart review was performed to establish presence and type of SSTI. PPVs and 95{\%} confidence intervals (CI) were calculated among all encounters, initial encounters, and cellulitis/abscess cases.Results: Of the 731 encounters included, 514 (70.3{\%}) were initial encounters and 448 (61.3{\%}) were cellulitis/abscess cases. When the presence of an ICD-9 code, CPT code, or positive culture was used to identify SSTIs, 617 encounters were true positives, yielding a PPV of 84.4{\%} [95{\%} CI: 81.8-87.0{\%}]. The PPV for using ICD-9 codes alone to identify SSTIs was 90.7{\%} [95 {\%} CI: 88.5-92.9{\%}]. For encounters with cellulitis/abscess codes, the PPV was 91.5{\%} [95{\%} CI: 88.9-94.1{\%}].Conclusions: ICD-9 codes may be used to retrospectively identify SSTIs with a high PPV. Broadening SSTI case identification with microbiology data and CPT codes attenuates the PPV. Further work is needed to estimate the sensitivity of this method.",
keywords = "Abscess, Methodologies, Positive predictive value, Primary care, Skin infection",
author = "Levine, {Pamela J.} and Elman, {Miriam R.} and Ravina Kullar and John Townes and Bearden, {David T.} and Rowena Vilches-Tran and Ian McClellan and McGregor, {Jessina C.}",
year = "2013",
month = "4",
day = "10",
doi = "10.1186/1471-2334-13-171",
language = "English (US)",
volume = "13",
journal = "BMC Infectious Diseases",
issn = "1471-2334",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Use of electronic health record data to identify skin and soft tissue infections in primary care settings

T2 - A validation study

AU - Levine, Pamela J.

AU - Elman, Miriam R.

AU - Kullar, Ravina

AU - Townes, John

AU - Bearden, David T.

AU - Vilches-Tran, Rowena

AU - McClellan, Ian

AU - McGregor, Jessina C.

PY - 2013/4/10

Y1 - 2013/4/10

N2 - Background: Epidemiologic studies of skin and soft tissue infections (SSTIs) depend upon accurate case identification. Our objective was to evaluate the positive predictive value (PPV) of electronic medical record data for identification of SSTIs in a primary care setting.Methods: A validation study was conducted among primary care outpatients in an academic healthcare system. Encounters during four non-consecutive months in 2010 were included if any of the following were present in the electronic health record: International Classification of Diseases, Ninth Revision (ICD-9) code for an SSTI, Current Procedural Terminology (CPT) code for incision and drainage, or a positive wound culture. Detailed chart review was performed to establish presence and type of SSTI. PPVs and 95% confidence intervals (CI) were calculated among all encounters, initial encounters, and cellulitis/abscess cases.Results: Of the 731 encounters included, 514 (70.3%) were initial encounters and 448 (61.3%) were cellulitis/abscess cases. When the presence of an ICD-9 code, CPT code, or positive culture was used to identify SSTIs, 617 encounters were true positives, yielding a PPV of 84.4% [95% CI: 81.8-87.0%]. The PPV for using ICD-9 codes alone to identify SSTIs was 90.7% [95 % CI: 88.5-92.9%]. For encounters with cellulitis/abscess codes, the PPV was 91.5% [95% CI: 88.9-94.1%].Conclusions: ICD-9 codes may be used to retrospectively identify SSTIs with a high PPV. Broadening SSTI case identification with microbiology data and CPT codes attenuates the PPV. Further work is needed to estimate the sensitivity of this method.

AB - Background: Epidemiologic studies of skin and soft tissue infections (SSTIs) depend upon accurate case identification. Our objective was to evaluate the positive predictive value (PPV) of electronic medical record data for identification of SSTIs in a primary care setting.Methods: A validation study was conducted among primary care outpatients in an academic healthcare system. Encounters during four non-consecutive months in 2010 were included if any of the following were present in the electronic health record: International Classification of Diseases, Ninth Revision (ICD-9) code for an SSTI, Current Procedural Terminology (CPT) code for incision and drainage, or a positive wound culture. Detailed chart review was performed to establish presence and type of SSTI. PPVs and 95% confidence intervals (CI) were calculated among all encounters, initial encounters, and cellulitis/abscess cases.Results: Of the 731 encounters included, 514 (70.3%) were initial encounters and 448 (61.3%) were cellulitis/abscess cases. When the presence of an ICD-9 code, CPT code, or positive culture was used to identify SSTIs, 617 encounters were true positives, yielding a PPV of 84.4% [95% CI: 81.8-87.0%]. The PPV for using ICD-9 codes alone to identify SSTIs was 90.7% [95 % CI: 88.5-92.9%]. For encounters with cellulitis/abscess codes, the PPV was 91.5% [95% CI: 88.9-94.1%].Conclusions: ICD-9 codes may be used to retrospectively identify SSTIs with a high PPV. Broadening SSTI case identification with microbiology data and CPT codes attenuates the PPV. Further work is needed to estimate the sensitivity of this method.

KW - Abscess

KW - Methodologies

KW - Positive predictive value

KW - Primary care

KW - Skin infection

UR - http://www.scopus.com/inward/record.url?scp=84875935842&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875935842&partnerID=8YFLogxK

U2 - 10.1186/1471-2334-13-171

DO - 10.1186/1471-2334-13-171

M3 - Article

C2 - 23574801

AN - SCOPUS:84875935842

VL - 13

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

SN - 1471-2334

IS - 1

M1 - 171

ER -