Validation of acute exacerbation of chronic obstructive pulmonary disease recording in electronic health records: a systematic review
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Objective: Acute exacerbations of COPD(AECOPD) can have severe impacts on patients with the disease and a heavy burden on health care 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 aims to summarize 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 2784 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 Classification of Diseases (ICD) Ninth Revision, Clinical Modification and Tenth Revision (ICD-9-CM and ICD-10), along with the Read codes from United Kingdom general practices. AECOPD can be identified within EHRs using validated definitions, however, the validity of AECOPD definitions varies considerably depending on the algorithm used and the settings to which they are applied.
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.
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 2784 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 Classification of Diseases (ICD) Ninth Revision, Clinical Modification and Tenth Revision (ICD-9-CM and ICD-10), along with the Read codes from United Kingdom general practices. AECOPD can be identified within EHRs using validated definitions, however, the validity of AECOPD definitions varies considerably depending on the algorithm used and the settings to which they are applied.
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.
Date Issued
2025-02-01
Date Acceptance
2025-01-07
Citation
Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 2025, 12 (2), pp.190-202
ISSN
2372-952X
Publisher
COPD Foundation
Start Page
190
End Page
202
Journal / Book Title
Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation
Volume
12
Issue
2
Copyright Statement
© 2025 COPD Foundation. For personal use only. Permission required for all other uses.
Identifier
10.15326/jcopdf.2024.0577
Subjects
AECOPD=acute exacerbation of COPD
CI=confidence interval
COPD=chronic obstructive pulmonary disease
CPRD=Clinical Practice Research Datalink
DPC=Diagnosis Procedure Combination
eCRF=electronic case report form
EHR=electronic health record
FCE=functional capacity evaluation
GOLD=Global initiative for chronic Obstructive Lung Disease
GP=general practitioner
HES=Hospital Episode Statistics
ICD-9-CM=International Classification of Diseases, Ninth Revision, Clinical Modification
ICD-10=International Classification of Diseases, Tenth Revision
LRTI=lower respiratory tract infection
NPV=negative predictive value
OCS=oral corticosteroid
PPV=positive predictive value
SNOMED CT=Systematized Nomenclature of Medicine Clinical Terms
Publication Status
Published
Date Publish Online
2025-02-05