Document Detail


The positive predictive value of a hyperkalemia diagnosis in automated health care data.
MedLine Citation:
PMID:  20878650     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Our objectives were to determine performance of coded hyperkalemia diagnosis at identifying (1) clinically evident hyperkalemia and (2) serum potassium>6 mmol/L.
METHODS: This retrospective observational study included 8722 patients with diabetes within an integrated healthcare system who newly initiated an angiotensin converting enzyme inhibitor, angiotensin receptor blocker, or spironolactone. The primary outcome was first hyperkalemia-associated event (hospitalization, emergency department visit or death within 24 hours of coded diagnosis and/or potassium≥6 mmol/L) during the first year of therapy. Medical records were reviewed.
RESULTS: Among a random sample of 99 patients not coded as having hyperkalemia, none had hyperkalemia upon record review. Among all 64 patients identified as having hyperkalemia, all had hospitalization or emergency department visit associated with coded diagnosis or elevated potassium. Of 55 with coded diagnosis, 42 (PPV 76%) had clinically evident hyperkalemia; 32 (PPV 58%) had potassium≥6. Of 9 identified using only potassium≥6, 7 (PPV 78%) had clinically evident hyperkalemia.
CONCLUSIONS: Nearly one-fourth of patients with coded diagnosis do not have clinically evident hyperkalemia and nearly one-half do not have potassium≥6. Because both false positives and negatives occur with coded diagnoses, medical record validation of hyperkalemia-associated outcomes is necessary.
Authors:
Marsha A Raebel; Michael L Smith; Gwyn Saylor; Leslie A Wright; Craig Cheetham; Christopher M Blanchette; Stanley Xu
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Validation Studies    
Journal Detail:
Title:  Pharmacoepidemiology and drug safety     Volume:  19     ISSN:  1099-1557     ISO Abbreviation:  Pharmacoepidemiol Drug Saf     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-27     Completed Date:  2011-02-07     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  9208369     Medline TA:  Pharmacoepidemiol Drug Saf     Country:  England    
Other Details:
Languages:  eng     Pagination:  1204-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 John Wiley & Sons, Ltd.
Affiliation:
Kaiser Permanente Colorado Institute for Health Research, Denver, CO 80237-8066, USA. marsha.a.raebel@kp.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiotensin Receptor Antagonists / adverse effects
Angiotensin-Converting Enzyme Inhibitors / adverse effects
Automation
Delivery of Health Care, Integrated
Diabetes Mellitus / epidemiology
False Negative Reactions
False Positive Reactions
Female
Humans
Hyperkalemia / chemically induced,  diagnosis*
Male
Medical Records Systems, Computerized / statistics & numerical data*
Middle Aged
Mineralocorticoid Receptor Antagonists / adverse effects
Potassium / blood*
Predictive Value of Tests
Retrospective Studies
Spironolactone / adverse effects
Grant Support
ID/Acronym/Agency:
R21DK075076/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Angiotensin Receptor Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Mineralocorticoid Receptor Antagonists; 52-01-7/Spironolactone; 7440-09-7/Potassium
Comments/Corrections

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