Table 2.
Performance of Validated Algorithms
| Author | Algorithm | Reference Standard | Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) | C Statistic |
|---|---|---|---|---|---|---|---|
| Chang et al19 | Discharge diagnosis with ICD-9 code 416.0 | Medical chart reviewa | 63.2 | 96.7 | 66.7 | … | … |
| Fox et al20 | CPRD: read codes: G41y000, G410.00, 7Q01300, 7Q01200, 7Q01100, 7Q01000, G42.11, G41z.00, G41.00 HES: ICD-10 code I27.0 |
Medical chart reviewb | … | … | 3.3 | … | … |
| Link et al21 | Discharge diagnosis with ICD-9 code 416.0 1999 2002 |
Medical chart reviewc | … | … | 6.7 33.3 |
… | … |
| Papani et al22 | Development cohort: claims-based algorithms: | Medical chart reviewd | |||||
| ICD-9 codes 416.0 and 416.8 | … | … | 9.3 | … | … | ||
| ICD codes plus at least one PAH-specific medication | 67.4 | 86.9 | 34.7 | 96.3 | 0.8 | ||
| ICD codes plus two or more classes of PAH-specific medications | 28.3 | 98.6 | 66.9 | 93.0 | 0.7 | ||
| Development cohort: EHR-based algorithms: | |||||||
| ICD codes plus EHR diagnosis | 76.9 | 77.1 | 25.7 | 97.0 | 0.7 | ||
| ICD codes plus EHR diagnosis plus ECHO | 76.9 | 78.2 | 26.6 | 97.0 | 0.7 | ||
| ICD codes plus EHR diagnosis plus ECHO plus RHC | 76.9 | 91.4 | 48.0 | 97.5 | 0.9 | ||
| ICD codes plus EHR diagnosis plus ECHO plus RHC plus medication | 67.4 | 96.9 | 69.4 | 96.7 | 0.9 | ||
| ICD codes plus EHR diagnosis plus medication | 67.4 | 96.5 | 66.2 | 96.6 | 0.9 | ||
| Validation cohort: claims-based algorithms | |||||||
| ICD-9 codes 416.0 and 416.8 | … | … | 15.8 | … | … | ||
| ICD codes plus at least one PAH-specific medication | 64.3 | 81.9 | 40.0 | 92.4 | … | ||
| ICD codes plus two or more classes of PAH-specific medications | 42.7 | 94.0 | 57.1 | 89.7 | … | ||
| Validation cohort: EHR-based algorithms | |||||||
| ICD codes plus EHR diagnosis | 25.0 | 85.9 | 25.0 | 85.9 | … | ||
| ICD codes plus EHR diagnosis plus ECHO | 25.0 | 91.3 | 35.0 | 86.6 | … | ||
| ICD codes plus EHR diagnosis plus ECHO plus RHC | 25.0 | 96.6 | 58.3 | 87.3 | … | ||
| ICD codes plus EHR diagnosis plus ECHO plus RHC plus medication | 17.9 | 98.0 | 62.5 | 86.4 | … | ||
| ICD codes plus EHR diagnosis plus medication | 17.9 | 96.0 | 45.5 | 86.1 | … |
CPRD = Clinical Practice Research Datalink; ECHO = echocardiogram; HES = Hospital Episodes Statistics; ICD-9 = International Classification of Diseases, Ninth Revision; ICD-10 = International Classification of Diseases, 10th Revision; NPV = negative predictive value; PPV = positive predictive value; RHC = right heart catheterization. See Table 1 legend for expansion of other abbreviations.
Review of patient discharge records including prior workup for PH, based on ICD diagnosis codes and procedure codes.
Review of the electronic health record including ICD diagnosis codes for PAH-associated diseases, ICD diagnosis codes for cardiac and respiratory diseases associated with PH but not PAH, procedure codes for RHCs, and prescriptions for pulmonary vasodilators.
Review of patient discharge records and prior workup for PH including progress notes, ECHO and RHC results, and imaging results.
Review of the electronic health record including age, sex, race, comorbidities, ECHO and RHC results, prescribed PAH-specific therapies, and CT angiography or ventilation-perfusion scan results.