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Open AccessArticle

Validating Use of Electronic Health Data to Identify Patients with Urinary Tract Infections in Outpatient Settings

1
Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77030, USA
2
Baylor College of Medicine, Houston, TX 77030, USA
3
Section of Infectious Diseases, Department of Medicine, Boston Veterans Affairs Healthcare System and Boston University School of Medicine, Boston, MA 02118, USA
4
Houston VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
5
Section of Infectious Diseases, Departments of Medicine and Surgery, Baylor College of Medicine, Houston, TX 77030, USA
*
Author to whom correspondence should be addressed.
Antibiotics 2020, 9(9), 536; https://doi.org/10.3390/antibiotics9090536
Received: 21 July 2020 / Revised: 21 August 2020 / Accepted: 24 August 2020 / Published: 25 August 2020
(This article belongs to the Special Issue Antimicrobial Stewardship in Primary Care)
Objective: To validate the use of electronic algorithms based on International Classification of Diseases (ICD)-10 codes to identify outpatient visits for urinary tract infections (UTI), one of the most common reasons for antibiotic prescriptions. Methods: ICD-10 symptom codes (e.g., dysuria) alone or in addition to UTI diagnosis codes plus prescription of a UTI-relevant antibiotic were used to identify outpatient UTI visits. Chart review (gold standard) was performed by two reviewers to confirm diagnosis of UTI. The positive predictive value (PPV) that the visit was for UTI (based on chart review) was calculated for three different ICD-10 code algorithms using (1) symptoms only, (2) diagnosis only, or (3) both. Results: Of the 1087 visits analyzed, symptom codes only had the lowest PPV for UTI (PPV = 55.4%; 95%CI: 49.3–61.5%). Diagnosis codes alone resulted in a PPV of 85% (PPV = 84.9%; 95%CI: 81.1–88.2%). The highest PPV was obtained by using both symptom and diagnosis codes together to identify visits with UTI (PPV = 96.3%; 95%CI: 94.5–97.9%). Conclusions: ICD-10 diagnosis codes with or without symptom codes reliably identify UTI visits; symptom codes alone are not reliable. ICD-10 based algorithms are a valid method to study UTIs in primary care settings. View Full-Text
Keywords: validation; ICD; urinary tract infection; outpatient; cystitis; PPV validation; ICD; urinary tract infection; outpatient; cystitis; PPV
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Germanos, G.; Light, P.; Zoorob, R.; Salemi, J.; Khan, F.; Hansen, M.; Gupta, K.; Trautner, B.; Grigoryan, L. Validating Use of Electronic Health Data to Identify Patients with Urinary Tract Infections in Outpatient Settings. Antibiotics 2020, 9, 536.

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