Aim

There is a need for large-scale epidemiological studies of paediatric out-of-hospital cardiac arrest (POHCA). To enable this, we developed and validated international classification of disease (ICD-10) search algorithms for the identification of POHCA patients from health administrative data.

Methods

We validated the algorithms with a registry of POHCA (CanRoc) as the reference standard. The reference standard included all atraumatic POHCA in Middlesex-London region for January 2012-June 2020. All algorithms included 1 day to <18-year-old patients transported to emergency department (ED) by ambulance and excluded trauma. We tested three algorithms, which were applied to the National Ambulatory Care Reporting System and Discharge Abstract Database. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ration (NLR) were calculated for each algorithm.

Results

During the study period, 17,688 children presented to the ED by ambulance. The reference standard included 51 POHCA patients. The algorithm using only ICD-10 code for cardiac arrest had a sensitivity of 65.5% and PPV of 90%. The algorithm with the highest sensitivity of 87.3% added sudden infant death syndrome, drowning or asphyxiation with CPR in addition to the cardiac arrest codes for inpatient and ED records. This algorithm had a specificity of 99.9%, PPV of 81.4% and NPV of ∼100.0%.

Conclusion

It is important that algorithms used for cohort identification are validated prior to use. The ICD-10 code for cardiac arrest alone misses many POHCA cases but the use of additional codes can improve the sensitivity while maintaining specificity.

中文翻译：

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验证 ICD-10 代码以识别儿童院外心脏骤停患者

目的

需要对儿童院外心脏骤停 (POHCA) 进行大规模流行病学研究。为此，我们开发并验证了国际疾病分类 (ICD-10) 搜索算法，用于从卫生管理数据中识别 POHCA 患者。

方法

我们使用 POHCA (CanRoc) 作为参考标准来验证算法。参考标准包括 2012 年 1 月至 2020 年 6 月米德尔塞克斯-伦敦地区的所有非创伤性 POHCA。所有算法包括由救护车运送到急诊室 (ED) 的 1 天至 18 岁以下患者并排除创伤。我们测试了三种算法，这些算法应用于国家门诊护理报告系统和出院摘要数据库。计算每种算法的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性似然比（PLR）和阴性似然比（NLR）。

结果

在研究期间，有 17,688 名儿童乘坐救护车到急诊室就诊。参考标准包括 51 名 POHCA 患者。仅使用 ICD-10 代码进行心脏骤停的算法具有 65.5% 的灵敏度和 90% 的 PPV。灵敏度最高的算法为 87.3%，除了用于住院和 ED 记录的心脏骤停代码外，还添加了 CPR 导致的婴儿猝死综合征、溺水或窒息。该算法的特异性为 99.9%，PPV 为 81.4%，NPV 为 ∼100.0%。

结论

重要的是，用于群组识别的算法在使用前经过验证。仅用于心脏骤停的 ICD-10 代码就漏掉了许多 POHCA 病例，但使用附加代码可以提高敏感性，同时保持特异性。