Skip to main content

Table 3 Validity of administrative claims definitions for volume overload hospital admissions

From: Identification of volume overload hospitalizations among hemodialysis patients using administrative claims: a validation study

Claims-based definition

n (%)a

SENS (95 % CI)b

SPEC (95 % CI)b

PPV (95 % CI)b

NPV (95 % CI)b

ICD-9 discharge codes could be in any position

 1. Fluid overload

30 (9.5)

32.5 (22.2, 44.1)

97.9 (95.2, 99.3)

83.3 (65.3, 94.4)

81.8 (76.8, 86.1)

 2. Pulmonary edema

13 (4.1)

11.7 (5.5, 21.0)

98.3 (95.8, 99.5)

69.2 (38.6, 90.9)

77.5 (72.3, 82.1)

 3. Heart failure

87 (27.6)

51.9 (40.3, 63.5)

80.3 (74.6, 85.1)

46.0 (35.2, 57.0)

83.8 (78.3, 88.3)

 4. Fluid overload or pulmonary edema

39 (12.4)

40.3 (29.2, 52.1)

96.6 (93.5, 98.5)

79.5 (63.5, 90.7)

83.3 (78.4, 87.5)

 5. Fluid overload or pleural effusion

39 (12.4)

41.6 (30.4, 53.4)

97.1 (94.0, 98.8)

82.1 (66.5, 92.5)

83.7 (78.8, 87.9)

 6. Fluid overload or heart failure

111 (35.2)

76.6 (65.6, 85.5)

78.2 (72.4, 83.2)

53.2 (43.4, 62.7)

91.2 (86.4, 94.7)

 7. Fluid overload, pulmonary edema or heart failure

117 (37.1)

81.8 (71.4, 89.7)

77.3 (71.5, 82.5)

53.8 (44.4, 63.1)

92.9 (88.4, 96.1)

ICD-9 discharge codes could be in primary position only

 1. Fluid overload

5 (1.6)

6.5 (2.1, 14.5)

100.0 (98.5, 100.0)

100.0 (47.8, 100.0)

76.8 (71.7, 81.4)

 2. Pulmonary edema

5 (1.6)

6.5 (2.1, 14.5)

100.0 (98.5, 100.0)

100.0 (47.8, 100.0)

76.8 (71.7, 81.4)

 3. Heart failure

10 (3.2)

11.7 (5.5, 21.0)

99.6 (97.7, 100.0)

90.0 (55.5, 99.7)

77.7 (72.6, 82.3)

 4. Fluid overload or pulmonary edema

10 (3.2)

13.0 (6.4, 22.6)

100.0 (98.5, 100.0)

100.0 (69.2, 100.0)

78.0 (73.0, 82.6)

 5. Fluid overload or pleural effusion

6 (1.9)

6.5 (2.1, 14.5)

99.6 (97.7, 100.0)

83.3 (35.9, 99.6)

76.7 (71.6, 81.3)

 6. Fluid overload or heart failure

15 (4.8)

18.2 (10.3, 28.6)

99.6 (97.7, 100.0)

93.3 (68.1, 99.8)

79.0 (73.9, 83.5)

 7. Fluid overload, pulmonary edema or heart failure

20 (6.3)

24.7 (15.6, 35.8)

99.6 (97.7, 100.0)

95.0 (75.1, 99.9)

80.3 (75.3, 84.7)

ICD-9 discharge codes could be in primary or leading secondary positions

 1. Fluid overload

5 (1.6)

6.5 (2.1, 14.5)

100.0 (98.5, 100.0)

100.0 (47.8, 100.0)

76.8 (71.7, 81.4)

 2. Pulmonary edema

7 (2.2)

9.1 (3.7, 17.8)

100.0 (98.5, 100.0)

100.0 (59.0, 100.0)

77.3 (72.2, 81.8)

 3. Heart failure

15 (4.8)

16.9 (9.3, 27.1)

99.2 (97.0, 99.9)

86.7 (59.5, 98.3)

78.7 (73.6, 83.2)

 4. Fluid overload or pulmonary edema

12 (3.8)

15.6 (8.3, 25.6)

100.0 (98.5, 100.0)

100.0 (73.5, 100.0)

78.5 (73.5, 83.0)

 5. Fluid overload or pleural effusion

6 (1.9)

6.5 (2.1, 14.5)

99.6 (97.7, 100.0)

83.3 (35.9, 99.6)

76.7 (71.6, 81.3)

 6. Fluid overload or heart failure

20 (6.3)

23.4 (14.5, 34.4)

99.2 (97.0, 99.9)

90.0 (68.3, 98.8)

80.0 (75.0, 84.4)

 7. Fluid overload, pulmonary edema or heart failure

27 (8.6)

32.5 (22.2, 44.1)

99.2 (97.0, 99.9)

92.6 (75.7, 99.1)

81.9 (77.0, 86.2)

  1. Abbreviations: 95 % CI 95 % confidence interval, ICD-9 International Classification of Diseases, Ninth Revision, NPV negative predictive value, PPV positive predictive value, SENS sensitivity, SPEC specificity
  2. aCount (prevalence) of volume overload admissions identified by each administrative claims definition in the study cohort (N = 315)
  3. bValidity estimates and 95 % CIs are expressed as percentages. Clinically adjudicated volume overload events, as outlined in Fig. 1, served as the reference standard. In the study cohort there were 77 adjudicated volume overload admissions
Back to article page

BMC Nephrology

ISSN: 1471-2369

Contact us