Validation of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Recording in Electronic Health Records: A Systematic Review.

Abstract

Objective: Acute exacerbations of COPD (AECOPD) can have severe impacts on patients with the disease and a heavy burden on healthcare resources. Electronic health records (EHRs) are a valuable resource for identifying cases of AECOPD and research. Studies have attempted to validate case definitions of AECOPD and this review aimed to summarise validated AECOPD definitions in EHRs, and to provide guidance on the best algorithms to use to ensure accurate cohorts of AECOPD cases are available for researchers using EHRs.

Methods: MEDLINE and Embase were searched and studies that met the inclusion criteria were reviewed by ≥2 reviewers. Data extracted included the algorithms used to identify AECOPD, the reference standards used to compare against the algorithm, and measures of validity. The risk of bias was assessed using QUADAS-2 adapted for this review.

Results: Out of 2,784 studies found by the search strategy, 12 met the inclusion criteria. The clinical terminology used to build algorithms to detect AECOPD included codes from the International Statistical Classification of Diseases and Related Health Problems (ICD) 9^th and 10^th editions (ICD-9 and ICD-10), along with Read codes from UK general practices. AECOPD can be identified within EHRs using validated definitions, however the validity of AECOPD definitions vary considerably depending on the algorithm used and the settings they are applied in.

Conclusion: Although there are validated definitions that can be used to identify AECOPD, there is no clear consensus on which provides the highest validity or the most sensitive and specific definition to use.