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Positive Predictive Values of Anaphylaxis Diagnosis in Claims Data: A Multi-Institutional Study in Taiwan

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Abstract

Real-world data sources can facilitate essential understanding of the epidemiological features of anaphylaxis. However, the accuracy of case-identifying definitions based on diagnosis codes for anaphylaxis in healthcare databases remains understudied. We conducted a cross-sectional study analyzing claims data from the largest multi-institutional healthcare system in Taiwan during 2017–2021. We included patients with incident anaphylaxis identified by either ICD-10-CM codes for anaphylaxis (Group 1) or ICD-10-CM codes for severe allergic or drug adverse events and additional modifier codes for acute allergy events (Group 2). We randomly selected 20% of the cases to determine the positive predictive value (PPV) of anaphylaxis case-identifying definitions in Groups 1 and 2 after review of electronic medical records by two physicians. From the original cohort (n = 2,176), we randomly selected 433 patients with either a diagnosis of anaphylaxis (Group 1), or a diagnosis of severe allergic and drug adverse events with additional modifier codes for acute allergy events (Group 2). In Group 1, we judged 135 / 170 patients as true anaphylaxis cases, giving a PPV of 79.4% (95% CI: 73.3–85.5). In Group 2, we judged 47 / 263 patients as true anaphylaxis cases, giving a PPV of 17.9% (95% CI: 13.3–22.5). In conclusion, acceptable PPVs were observed when anaphylaxis cases were identified by ICD-10-CM codes for anaphylaxis, but not by ICD-10-CM codes for severe allergic or drug adverse event with additional modifier codes for acute allergy events. Our multi-institutional findings could serve as a fundamental reference for further studies of anaphylaxis based on real-world healthcare databases.

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Data availability

Access to the analyzed electronic medical records data requires official approval from Chang Gung Memorial Hospitals (CGMF). For data privacy and safety concerns, all analyses are required to be conducted onsite at the CGMF, and no patient-level data can be taken out. However, the SAS programming codes for the study analysis are available from the corresponding author upon reasonable request.

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Funding

This study was supported by grants from Keelung Chang Gung Memorial Hospital, Taiwan (CGRPG2M0012). The funder had no part in this study, including study design and conduct, data collection, management, analysis and interpretation, manuscript preparation, review and approval, and decision to publish.

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Authors and Affiliations

  1. Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, 222 Maijin Rd, Keelung, Taiwan

    Chun Chang & Shu-Chen Liao

  2. College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Chun Chang & Shu-Chen Liao

  3. Department of Pharmacy, Keelung Chang Gung Memorial Hospital, 222 Maijin Rd, Keelung, Taiwan

    Shih-Chieh Shao

  4. School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Shih-Chieh Shao

Authors
  1. Chun Chang
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  2. Shu-Chen Liao
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Contributions

Shao and Liao conceived of the presented idea. Chang and Liao conducted the analysis. Chang and Shao wrote the first draft. Chang and Liao interpreted the findings. All authors critically reviewed the manuscript for intellectual content and approved the final version of the paper.

Corresponding authors

Correspondence to Shu-Chen Liao or Shih-Chieh Shao.

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Competing interests

The authors declare no competing interests.

Ethics approval

In accordance with the principles laid down in the Declaration of Helsinki, this study protocol has been reviewed and approved by the Institutional Review Board of CGMF (IRB No: 202200229B0). The requirement for informed consent was waived due to the retrospective design.

Conflicts of interest

The authors declare no potential conflicts of interest with regard to this study.

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Chang, C., Liao, SC. & Shao, SC. Positive Predictive Values of Anaphylaxis Diagnosis in Claims Data: A Multi-Institutional Study in Taiwan. J Med Syst 47, 97 (2023). https://doi.org/10.1007/s10916-023-01989-2

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