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Improving Surveillance for Pediatric Clostridium difficile Infection: Derivation and Validation of an Accurate Case-finding Tool

Shaklee, Julia MD*; Zerr, Danielle M. MD, MPH; Elward, Alexis MD, MPH; Newland, Jason MD§; Leckerman, Kateri MS; Asti, Lindsey MPH; Guth, Rebecca MPH**; Bass, Julie DO§; Selvarangan, Rangaraj PhD††; Coffin, Susan MD, MPH‡‡; Zaoutis, Theoklis MD, MSCE§§

The Pediatric Infectious Disease Journal: March 2011 - Volume 30 - Issue 3 - p e38-e40
doi: 10.1097/INF.0b013e3182027c22
Online-Only: Original Studies

Background: The incidence of Clostridium difficile infection (CDI) is increasing. Multicenter studies of CDI have been limited by the lack of valid case-finding tools. To facilitate pediatric studies of CDI, we constructed a case-finding tool using administrative data.

Methods: A cross-sectional study was performed using the Pediatric Health Information System database and microbiologic data from 4 member hospitals. Using patients with laboratory-confirmed CDI as the standard, we determined the sensitivity, specificity, positive (PPV), and negative (NPV) predictive value of an ICD-9-CM code for identifying children with laboratory-confirmed CDI.

Results: We identified 109 patients with laboratory-confirmed CDI and 119 patients with CDI ICD-9-CM code. The sensitivity, specificity, PPV, and NPV were 80.73%, 99.89%, 73.95%, and 99.92%, respectively, for this comparison. The addition of a billing charge for both C. difficile laboratory test and treatment medication to the ICD-9-CM code increased the specificity and PPV, but resulted in a slight decrease in the sensitivity and NPV. The use of administrative data for identifying pediatric cases of CDI was also compared with that of chart review, and was found to be a stronger surrogate for identifying cases of CDI when compared with microbiology data alone.

Conclusions: These results demonstrate that the use of administrative data for CDI is a reliable and accurate method for identifying pediatric patients with CDI. The use of administrative data could facilitate the completion of larger studies due to its greater accessibility and reduced costs.

From the *Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA; †Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA; ‡Department of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO; §Department of Pediatrics, Children's Mercy Hospital & Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, MO; ¶Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA; **Office of Pediatric Quality Management, St. Louis Children's Hospital, St. Louis, MO; ††Department of Pathology, Children's Mercy Hospital & Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, MO; ‡‡Department of Pediatrics, Division of Infectious Diseases, University of Pennsylvania School of Medicine, Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, PA; and §§Department of Pediatrics, Center for Clinical Epidemiology, University of Pennsylvania School of Medicine, Division of Infectious Diseases and The Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA.

Accepted for publication October 19, 2010.

Presented in part (poster) at the Annual Meeting of the Infectious Diseases Society of America, October 2009, Philadelphia, PA.

Address for correspondence: Theoklis Zaoutis, MD, MSCE, Division of Infectious Diseases, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA 19104. E-mail: zaoutis@email.chop.edu.

© 2011 Lippincott Williams & Wilkins, Inc.