Validation for using electronic health records to identify community acquired pneumonia hospitalization among people with and without HIV

Table 3 Incidence Rates (IR) and Hazard Ratios (HR) for community-acquired pneumonia (CAP) identified in electronic health records (EHR) by ICD-9 codes and restricted to those with confirmed CAP by chart review (confirmed-CAP) in PWH and HIV-uninfected (Uninf) subjects

	In VACS Survey Cohort							Of those initially identified as having an EHR CAP-related code
	Frequency		IR		PWH to Uninfected					PPV
	PWH N = 3410	Uninf N = 3414	PWH	Uninf	HR	P	95% CI	Total	Confirmed-CAP	Total	PWH	Uninf	p-value
All codes	433	116	2.98	0.70	4.25	<.001	3.45–5.22	549	397	72%	74%	66%	0.065
All codes plus Abx	415	104	2.84	0.63	4.54	<.001	3.65–5.64	519	386	74%	76%	69%	0.18
Algorithm 1, 480–487 in any position	413	98	2.83	0.59	4.75	<.001	3.81–5.94	511	380	74%	76%	69%	0.21
Algorithm 1 plus Abx	398	88	2.72	0.53	5.10	<.001	4.04–6.44	486	369	76%	77%	73%	0.47
Algorithm 1, plus 507 in any position	426	114	2.92	0.69	4.22	<.001	3.43–5.21	540	393	73%	75%	66%	0.059
Algorithm 1, plus 507 in any position plus Abx	409	102	2.80	0.62	4.53	<.001	3.64–5.64	511	382	75%	76%	70%	0.181
Algorithm 2, 480–487 in primary or secondary position only to selected diagnosis^a	329	59	2.24	0.36	6.22	<.001	4.71–8.24	388	313	81%	82%	75%	0.2
Algorithm 2 plus abx	317	57	2.15	0.34	6.22	<.001	4.68–8.27	374	305	82%	83%	73%	0.096
Algorithm 2 plus 507	334	69	2.27	0.42	5.42	<.001	4.17–7.04	403	319	79%	81%	70%	0.031
Algorithm 2 plus 428	331	62	2.25	0.37	5.96	<.001	4.53–7.83	393	315	80%	82%	71%	0.048
Algorithm 2 plus 491	334	63	2.27	0.38	5.94	<.001	4.53–7.80	397	321	81%	82%	76%	0.3
Algorithm 2 plus 507, plus 428 and plus 491	341	76	2.32	0.46	5.03	<.001	3.91–6.47	417	341	79%	81%	68%	0.013
Confirmed-CAP	321	76	2.18	0.46	4.73	<.001	3.67–6.08	na	na	Na	na	na	na

HR, adjusted for age, race/ethnicity, and gender
All codes, refers to the initial set of CAP related ICD-9 codes used listed in methods
Plus Abx, refers to restricting to those that received antimicrobials within 72 h of admission identified by pharmacy package in EHR
480–487 refers to the set of restricted CAP codes
Plus 507 refers to allowing the aspiration code with the main set of CAP codes
^aCAP-related codes in primary position with the exception that they could be in secondary position if the following HIV, sepsis, respiratory insufficiency, and bacteremia codes were in primary position: 042, 038, 518.81, 518.82, 518.85, 995.91, 995.92, 790.7, 790.70
Plus 428 refers to adding the heart failure code to the non-CAP related codes allowed in primary position
Plus 491 refers to adding the COPD code to the non-CAP related codes allowed in primary position

ISSN: 2200-6133