Identification of Stevens-Johnson syndrome and toxic epidermal necrolysis in electronic health record databases

Robert Davis, Mia A. Gallagher, Maryam M. Asgari, Melody J. Eide, David J. Margolis, Eric Macy, James K. Burmester, Nandini Selvam, Joseph A. Boscarino, Lee F. Cromwell, Heather S. Feigelson, Jennifer L. Kuntz, Pamala A. Pawloski, Robert B. Penfold, Marsha A. Raebel, Gayathri Sridhar, Ann Wu, Lois A. La Grenade, Michael A. Pacanowski, Simone P. Pinheiro

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) carry a high mortality risk. While identifying clinical and genetic risk factors for these conditions has been hindered by their rarity, large electronic health databases hold promise for identifying large numbers of cases for study, especially with the introduction in 2008 of ICD-9 codes more specific for these conditions. Objective: The objective of this study is to estimate the validity of ICD-9 codes for ascertaining SJS/TEN in 12 collaborating research units in the USA, covering almost 60 million lives. Methods: From the electronic databases at each site, we ascertained potential cases of SJS/TEN using ICD-9 codes. At five sites, a subset of medical records was abstracted and standardized criteria applied by board-certified dermatologists to adjudicate diagnoses. Multivariate logistic regression was used to identify factors independently associated with validated SJS/TEN cases. Results: A total of 56591 potential cases of SJS/TEN were identified. A subset of 276 charts was selected for adjudication and 39 (of the 276) were confirmed as SJS/TEN. Patients with the ICD-9 codes introduced after 2008 were more likely to be confirmed as cases (OR 3.32; 95%CI 0.82, 13.47) than those identified in earlier years. Likelihood of case status increased with length of hospitalization. Applying the probability of case status to the 56591 potential cases, we estimated 475-875 to be valid SJS/TEN cases. Conclusion: Newer ICD-9 codes, along with length of hospitalization, identified patients with a high likelihood of SJS/TEN. This is important for identification of subjects for future pharmacogenomics studies.

Original languageEnglish (US)
Pages (from-to)684-692
Number of pages9
JournalPharmacoepidemiology and Drug Safety
Volume24
Issue number7
DOIs
StatePublished - Jul 1 2015

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Stevens-Johnson Syndrome
Electronic Health Records
International Classification of Diseases
Databases
Hospitalization
Medical Records
Logistic Models

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Pharmacology (medical)

Cite this

Identification of Stevens-Johnson syndrome and toxic epidermal necrolysis in electronic health record databases. / Davis, Robert; Gallagher, Mia A.; Asgari, Maryam M.; Eide, Melody J.; Margolis, David J.; Macy, Eric; Burmester, James K.; Selvam, Nandini; Boscarino, Joseph A.; Cromwell, Lee F.; Feigelson, Heather S.; Kuntz, Jennifer L.; Pawloski, Pamala A.; Penfold, Robert B.; Raebel, Marsha A.; Sridhar, Gayathri; Wu, Ann; La Grenade, Lois A.; Pacanowski, Michael A.; Pinheiro, Simone P.

In: Pharmacoepidemiology and Drug Safety, Vol. 24, No. 7, 01.07.2015, p. 684-692.

Research output: Contribution to journalArticle

Davis, R, Gallagher, MA, Asgari, MM, Eide, MJ, Margolis, DJ, Macy, E, Burmester, JK, Selvam, N, Boscarino, JA, Cromwell, LF, Feigelson, HS, Kuntz, JL, Pawloski, PA, Penfold, RB, Raebel, MA, Sridhar, G, Wu, A, La Grenade, LA, Pacanowski, MA & Pinheiro, SP 2015, 'Identification of Stevens-Johnson syndrome and toxic epidermal necrolysis in electronic health record databases', Pharmacoepidemiology and Drug Safety, vol. 24, no. 7, pp. 684-692. https://doi.org/10.1002/pds.3778
Davis, Robert ; Gallagher, Mia A. ; Asgari, Maryam M. ; Eide, Melody J. ; Margolis, David J. ; Macy, Eric ; Burmester, James K. ; Selvam, Nandini ; Boscarino, Joseph A. ; Cromwell, Lee F. ; Feigelson, Heather S. ; Kuntz, Jennifer L. ; Pawloski, Pamala A. ; Penfold, Robert B. ; Raebel, Marsha A. ; Sridhar, Gayathri ; Wu, Ann ; La Grenade, Lois A. ; Pacanowski, Michael A. ; Pinheiro, Simone P. / Identification of Stevens-Johnson syndrome and toxic epidermal necrolysis in electronic health record databases. In: Pharmacoepidemiology and Drug Safety. 2015 ; Vol. 24, No. 7. pp. 684-692.
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abstract = "Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) carry a high mortality risk. While identifying clinical and genetic risk factors for these conditions has been hindered by their rarity, large electronic health databases hold promise for identifying large numbers of cases for study, especially with the introduction in 2008 of ICD-9 codes more specific for these conditions. Objective: The objective of this study is to estimate the validity of ICD-9 codes for ascertaining SJS/TEN in 12 collaborating research units in the USA, covering almost 60 million lives. Methods: From the electronic databases at each site, we ascertained potential cases of SJS/TEN using ICD-9 codes. At five sites, a subset of medical records was abstracted and standardized criteria applied by board-certified dermatologists to adjudicate diagnoses. Multivariate logistic regression was used to identify factors independently associated with validated SJS/TEN cases. Results: A total of 56591 potential cases of SJS/TEN were identified. A subset of 276 charts was selected for adjudication and 39 (of the 276) were confirmed as SJS/TEN. Patients with the ICD-9 codes introduced after 2008 were more likely to be confirmed as cases (OR 3.32; 95{\%}CI 0.82, 13.47) than those identified in earlier years. Likelihood of case status increased with length of hospitalization. Applying the probability of case status to the 56591 potential cases, we estimated 475-875 to be valid SJS/TEN cases. Conclusion: Newer ICD-9 codes, along with length of hospitalization, identified patients with a high likelihood of SJS/TEN. This is important for identification of subjects for future pharmacogenomics studies.",
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AU - Davis, Robert

AU - Gallagher, Mia A.

AU - Asgari, Maryam M.

AU - Eide, Melody J.

AU - Margolis, David J.

AU - Macy, Eric

AU - Burmester, James K.

AU - Selvam, Nandini

AU - Boscarino, Joseph A.

AU - Cromwell, Lee F.

AU - Feigelson, Heather S.

AU - Kuntz, Jennifer L.

AU - Pawloski, Pamala A.

AU - Penfold, Robert B.

AU - Raebel, Marsha A.

AU - Sridhar, Gayathri

AU - Wu, Ann

AU - La Grenade, Lois A.

AU - Pacanowski, Michael A.

AU - Pinheiro, Simone P.

PY - 2015/7/1

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N2 - Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) carry a high mortality risk. While identifying clinical and genetic risk factors for these conditions has been hindered by their rarity, large electronic health databases hold promise for identifying large numbers of cases for study, especially with the introduction in 2008 of ICD-9 codes more specific for these conditions. Objective: The objective of this study is to estimate the validity of ICD-9 codes for ascertaining SJS/TEN in 12 collaborating research units in the USA, covering almost 60 million lives. Methods: From the electronic databases at each site, we ascertained potential cases of SJS/TEN using ICD-9 codes. At five sites, a subset of medical records was abstracted and standardized criteria applied by board-certified dermatologists to adjudicate diagnoses. Multivariate logistic regression was used to identify factors independently associated with validated SJS/TEN cases. Results: A total of 56591 potential cases of SJS/TEN were identified. A subset of 276 charts was selected for adjudication and 39 (of the 276) were confirmed as SJS/TEN. Patients with the ICD-9 codes introduced after 2008 were more likely to be confirmed as cases (OR 3.32; 95%CI 0.82, 13.47) than those identified in earlier years. Likelihood of case status increased with length of hospitalization. Applying the probability of case status to the 56591 potential cases, we estimated 475-875 to be valid SJS/TEN cases. Conclusion: Newer ICD-9 codes, along with length of hospitalization, identified patients with a high likelihood of SJS/TEN. This is important for identification of subjects for future pharmacogenomics studies.

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