Detection of Pelvic Inflammatory Disease: Development of an Automated Case-Finding Algorithm Using Administrative Data

ICD-9 codes are conventionally used to identify pelvic inflammatory disease (PID) from administrative data for surveillance purposes. This approach may include non-PID cases. To refine PID case identification among women with ICD-9 codes suggestive of PID, a case-finding algorithm was developed using additional variables. Potential PID cases were identified among women aged 15–44 years at Group Health (GH) and Kaiser Permanente Colorado (KPCO) and verified by medical record review. A classification and regression tree analysis was used to develop the algorithm at GH; validation occurred at KPCO. The positive predictive value (PPV) for using ICD-9 codes alone to identify clinical PID cases was 79%. The algorithm identified PID appropriate treatment and age 15–25 years as predictors. Algorithm sensitivity (GH = 96.4%; KPCO = 90.3%) and PPV (GH = 86.9%; KPCO = 84.5%) were high, but specificity was poor (GH = 45.9%; KPCO = 37.0%). In GH, the algorithm offered a practical alternative to medical record review to further improve PID case identification

Use of Administrative Health Care Data for Sexually Transmitted Disease Surveillance

We evaluated the usefulness of 3 administrative health care databases for sexually transmitted disease (STD) surveillance. Strengths include availability of diagnosis and procedure codes for large numbers of records. All data sources offer standardized data values. However, none of the sources include laboratory test results or inpatient medications, although several contain outpatient prescription claims. Despite limitations, administrative health care data provide new opportunities for STD surveillance among large numbers of health care consumers. These data may be particularly useful for non-reportable STD and STD clinical sequelae, but delayed availability may limit their utility for public health response.

Evaluation of Chlamydia Case Report Data: Completeness of Key Variables - United States, 2012

Chlamydia, a sexually transmitted infection, is the most commonly reported nationally notifable disease in the United States We assessed the completeness of key variables included in chlamydia case report data submitted to the Centers for Disease Control and Prevention (CDC) during 2012. Most of the reviewed demographic and geographic variables provided to CDC on 2012 chlamydia case reports had complete values. Diagnosis-related variables provided on case reports were less complete, in particular anatomic specimen site. Further investigation is needed to identify barriers to submitting complete data. Additional evaluation of validity (e.g., accuracy) of data provided is needed to fully evaluate chlamydia case report data

Evaluation of Chlamydia Case Report Data: Completeness of Key Variables - United States, 2012

Chlamydia, a sexually transmitted infection, is the most commonly reported nationally notifable disease in the United States We assessed the completeness of key variables included in chlamydia case report data submitted to the Centers for Disease Control and Prevention (CDC) during 2012. Most of the reviewed demographic and geographic variables provided to CDC on 2012 chlamydia case reports had complete values. Diagnosis-related variables provided on case reports were less complete, in particular anatomic specimen site. Further investigation is needed to identify barriers to submitting complete data. Additional evaluation of validity (e.g., accuracy) of data provided is needed to fully evaluate chlamydia case report data

Congenital syphilis: trends in mortality and morbidity in the United States, 1999 through 2013

BACKGROUND: Congenital syphilis (CS) results when an infected pregnant mother transmits syphilis to her unborn child prior to or at delivery. The severity of infection can range from a delivery at term without signs of infection to stillbirth or death after delivery. OBJECTIVE: We sought to describe CS morbidity and mortality during 1999 through 2013. STUDY DESIGN: National CS case data reported to Centers for Disease Control and Prevention during 1999 through 2013 were analyzed. Cases were classified as dead (stillbirths and deaths up to 12 months after delivery), morbid (cases with strong [physical, radiographic, and/or nonserologic laboratory] evidence of CS), and nonmorbid (cases with a normal physical examination reported, without strong evidence of infection). Annual rates of these cases were calculated. Cases were compared using selected maternal and infant criteria. RESULTS: During 1999 through 2013, 6383 cases of CS were reported: 6.5% dead, 33.6% morbid, 53.9% nonmorbid, and 5.9% unknown morbidity; 81.8% of dead cases were stillbirths. Rates of dead, morbid, and nonmorbid cases all decreased over this time period, but the overall proportions that were dead ormorbid cases did not significantly change. The overall case fatality ratio during 1999 through 2013 was 6.5%. Among cases of CS, maternal race/ethnicity was not associated with increased morbidity or death, although most cases (83%) occurred among black or Hispanic mothers. No or inadequate treatment for maternal syphilis, \u3c10 prenatal visits, and maternal nontreponemal titer \u3e1:8 increased the likelihood of a dead case; risk of a dead case increased with maternal nontreponemal titer (x2 for trend P \u3c .001). Infants with CS born alive at \u3c28 weeks’ gestation (relative risk, 107.4; P\u3c .001) or born weighing\u3c1500 g (relative risk, 43.9; P \u3c .001) were at greatly increased risk of death. CONCLUSION: CS remains an important preventable cause of perinatal morbidity and mortality, with comparable case fatality ratios during 1999 through 2013 (6.5%) and 1992 through 1998 (6.4%). Detection and treatment of syphilis early during pregnancy remain crucial to reducing CS morbidity and mortality