Abstract
ObjectiveComplicated ectopic pregnancies with severe bleeding (CEPSB) are life-threatening situations and should be considered maternal near-miss cases. Previous studies have found an association between severe maternal morbidity secondary to CEPSB and substandard care. Almost all women with CEPSB are hospitalized, generating administrative and medical records. The objective of this study was to propose a method to measure the validity of the hospital discharge database (HDD) to detect CEPSB among hospital stays in two gynecological units.MethodsWe included all hospital stays of women who were 18–45 years old and hospitalized for acute pelvic pain or/and metrorrhagia in the two hospitals. The HDD was compared to medical data (gold standard). Two algorithms constructed from the International Classification of Disease (ICD-10) and Common Classification of Medical Procedures (CCAM), were applied to the HDD: a “predefined algorithm” according to coding guidelines and a “pragmatic algorithm” based on coding practices. Sensitivity, specificity and positive likelihood-ratios were calculated. False negatives and positives were analyzed to describe coding practices.ResultsAmong 370 hospital stays included, 52 were classified as CEPSB cases. The “predefined algorithm” gave a sensitivity of 23.1% (95% CI: 11.6–34.5) and a specificity of 99.1% (95% CI: 98.0–100.0) to identify CEPSB. The “pragmatic algorithm” gave a sensitivity of 63.5% (95% CI: 50.4–76.5) and a specificity of 94.7% (95% CI: 92.2–97.5) to identify CEPSB. Coding errors (77.6%) were due to misuse of diagnosis codes and because complications were not coded.ConclusionHDD is not reliable enough to detect CEPSB due to incorrect coding practices. However, it could be an ideal tool to monitor quality of care if a culture in data quality assessment is developed to improve quality of medical information.
Highlights
Ectopic pregnancies (EPs) account for approximately 2 to 3% of pregnancies each year [1,2,3,4,5]
The “predefined algorithm” gave a sensitivity of 23.1% and a specificity of 99.1% to identify complicated EPs with severe bleeding (CEPSB)
The objective of this study was to propose a method to measure the validity of the hospital discharge database (HDD) to detect CEPSB among hospital stays in two gynecological units
Summary
Ectopic pregnancies (EPs) account for approximately 2 to 3% of pregnancies each year [1,2,3,4,5]. Tubal rupture occurs in 22 to 34% of cases and often results in hemoperitoneum [2]. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom, covering the period from 2006 to 2008, estimated a fatality rate of 16.9 (95% CI 7.6–37.6) per 100 000 EPs [6]. A study from the United States estimated EP to be the most common cause of mortality during the first trimester of pregnancy [7]. Complicated EPs with severe bleeding (CEPSB) are life-threatening situations and should be considered maternal near-miss cases. Reducing the incidence of complications of EP is a national public health goal in France as in other countries in the world [8,9,10]
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