Administrative databases and trends in in-hospital deaths in pulmonary embolism.

Abstract

T he recent article by Tsai et al 1 highlights the trends in in-hospital deaths among hospitalizations with pulmonary embolism. Using the National Hospital Discharge Survey, they report a decreasing trend in case fatality rate between the years 2001 and 2008. Our group also recently investigated the outcomes of acute pulmonary embolism from the Nationwide Inpatient Sample, the largest all-payer inpatient care database in the United States, between the periods 2000 and 2008. Although we were looking at the differences in outcomes between weekend and weekday hospitalizations for patients admitted with a primary diagnosis of pulmonary embolism, we noted a significant trend in declining inpatient mortality. We used data from all patients coded with primary diagnosis of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 415.11 and 415.19. These ICD9-CM codes have been validated before, with a positive predictive value of 95%. We think that the similar results from these 2 reports from different large databases reflect the importance of using administrative databases to examine trends in outcomes for common medical conditions. They represent timely, “real-world” analyses of questions that may be too difficult to address using prospective randomized methods or extensive retrospective medical chart reviews. Use of large databases provides an important analytical resource as we embark on improving national health care efficacy in the current challenging environment.