Diagnosis Codes and Case Definitions for Neonatal Abstinence Syndrome.
Data Accuracy
Female
Florida
Humans
Infant, Newborn
International Classification of Diseases
/ standards
Neonatal Abstinence Syndrome
/ classification
Predictive Value of Tests
Pregnancy
Pregnancy Complications
Registries
Retrospective Studies
Sensitivity and Specificity
Substance-Related Disorders
/ complications
Journal
Pediatrics
ISSN: 1098-4275
Titre abrégé: Pediatrics
Pays: United States
ID NLM: 0376422
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
accepted:
16
06
2020
pubmed:
28
8
2020
medline:
8
10
2020
entrez:
28
8
2020
Statut:
ppublish
Résumé
The increase in neonatal abstinence syndrome (NAS) has underscored the need for NAS surveillance programs, but many rely on passive surveillance using unverified diagnosis codes. Few studies have evaluated the validity of these codes, and no study has assessed the recently proposed Council of State and Territorial Epidemiologists (CSTE) case definition. The Florida Birth Defects Registry investigated the accuracy of We identified a sample of infants born during 2016 coded with P96.1 and/or P04.49. Record review was completed for 128 cases coded with P96.1, 68 with P04.49, and 7 with both codes. Lacking consensus regarding a gold standard definition of NAS, we used clinical data to classify each case using the Florida and CSTE definitions. The code-specific accuracy was measured by using the positive predictive value (PPV). The clinical characteristics indicative of NAS were compared for case classification based on both definitions. By using the Florida definition, the overall PPV was 68% but varied by code: 95.3% for P96.1 and 13.2% for P04.49. The overall (47.8%) and code-specific PPVs were lower by using the CSTE definition. Comparison of clinical characteristics demonstrated that 60.7% of cases classified as no NAS by using the CSTE definition had robust clinical signs of NAS. In our sample, the CSTE case definition underestimated NAS prevalence. Only the P96.1
Sections du résumé
BACKGROUND AND OBJECTIVES
The increase in neonatal abstinence syndrome (NAS) has underscored the need for NAS surveillance programs, but many rely on passive surveillance using unverified diagnosis codes. Few studies have evaluated the validity of these codes, and no study has assessed the recently proposed Council of State and Territorial Epidemiologists (CSTE) case definition. The Florida Birth Defects Registry investigated the accuracy of
METHODS
We identified a sample of infants born during 2016 coded with P96.1 and/or P04.49. Record review was completed for 128 cases coded with P96.1, 68 with P04.49, and 7 with both codes. Lacking consensus regarding a gold standard definition of NAS, we used clinical data to classify each case using the Florida and CSTE definitions. The code-specific accuracy was measured by using the positive predictive value (PPV). The clinical characteristics indicative of NAS were compared for case classification based on both definitions.
RESULTS
By using the Florida definition, the overall PPV was 68% but varied by code: 95.3% for P96.1 and 13.2% for P04.49. The overall (47.8%) and code-specific PPVs were lower by using the CSTE definition. Comparison of clinical characteristics demonstrated that 60.7% of cases classified as no NAS by using the CSTE definition had robust clinical signs of NAS. In our sample, the CSTE case definition underestimated NAS prevalence.
CONCLUSIONS
Only the P96.1
Identifiants
pubmed: 32848030
pii: peds.2020-0567
doi: 10.1542/peds.2020-0567
pmc: PMC7461215
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NIGMS NIH HHS
ID : T32 GM081740
Pays : United States
Informations de copyright
Copyright © 2020 by the American Academy of Pediatrics.
Déclaration de conflit d'intérêts
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
Références
MMWR Morb Mortal Wkly Rep. 2018 Aug 10;67(31):845-849
pubmed: 30091969
J Anal Toxicol. 2009 Sep;33(7):351-5
pubmed: 19796504
Addiction. 1995 Feb;90(2):227-32
pubmed: 7703816
Am J Public Health. 2019 Sep;109(9):1193-1197
pubmed: 31318590
MMWR Morb Mortal Wkly Rep. 2016 Aug 12;65(31):799-802
pubmed: 27513154
MMWR Morb Mortal Wkly Rep. 2019 Feb 22;68(7):177-180
pubmed: 30789880
Pediatrics. 2019 Jan;143(1):
pubmed: 30514781