The design and implementation of a new surveillance system for venous thromboembolism using combined active and passive methods

doi:10.1016/j.ahj.2015.06.004

American Heart Journal

Volume 170, Issue 3, September 2015, Pages 447-454.e18

https://doi.org/10.1016/j.ahj.2015.06.004 Get rights and content

Estimates of venous thromboembolism (VTE) incidence in the United States are limited by lack of a national surveillance system. We implemented a population-based surveillance system in Oklahoma County, OK, for April 1, 2012 to March 31, 2014, to estimate the incidences of first-time and recurrent VTE events, VTE-related mortality, and the proportion of case patients with provoked versus unprovoked VTE. The Commissioner of Health made VTE a reportable condition and delegated surveillance-related responsibilities to the University of Oklahoma, College of Public Health. The surveillance system included active and passive methods. Active surveillance involved reviewing imaging studies (such as chest computed tomography and compression ultrasounds) from all inpatient and outpatient facilities. Interrater agreement between surveillance officers collecting data was assessed using κ. Passive surveillance used International Classification of Disease, Ninth Revision (ICD-9) codes from hospital discharge data to identify cases. The sensitivity and specificity of various ICD-9–based case definitions will be assessed by comparison with cases identified through active surveillance. As of February 1, 2015, we screened 54,494 (99.5%) of the imaging studies and identified 2,725 case patients, of which 91.6% were from inpatient facilities, and 8.4% were from outpatient facilities. Agreement between surveillance officers was high (κ ≥0.61 for 93.2% of variables). Agreement for the diagnosis of pulmonary embolism and diagnosis of deep vein thrombosis was κ = 0.92 (95% CI 0.74-1.00) and κ = 0.89 (95% CI 0.71-1.00), respectively. This surveillance system will provide data on the accuracy of ICD-9–based case definitions for surveillance of VTE events and help the Centers for Disease Control and Prevention develop a national VTE surveillance system.

Section snippets

Surveillance system objectives

The primary aims of our pilot surveillance system were to (1) develop and implement a population-based surveillance system for DVT and PE in Oklahoma County, OK, that includes both active and passive surveillance activities and which can accurately capture outpatient, inpatient, and death-related VTE events and distinguish first episode (incident) from recurrent VTE events; (2) estimate the annual incidence of first-episode VTE events and DVT and PE separately, (3) estimate the annual incidence

Results

All 13 inpatient facilities in Oklahoma County and the Oklahoma City VA Medical Center were included in this surveillance system. Fifty-six outpatient facilities were identified as being potentially eligible for surveillance; however, after contacting each facility, only 8 facilities met the criteria to be included in the surveillance, each of which contributed data to the surveillance system. As of February 1, 2015, we have screened 54,494 (99.5%) of 54,782 identified imaging records of

Discussion

We established a pilot population-based surveillance system for VTE using both active and passive methods in Oklahoma County, OK, to inform CDC regarding the development of future national VTE surveillance. We designed this system to (1) improve VTE-related estimates of the incidence of first-time and recurrent events and mortality rates, (2) differentiate between provoked and unprovoked events as well as describe these patients by demographic characteristics (including race/ethnicity), and (3)

Conclusions

In conclusion, we developed a pilot population-based surveillance system for VTE in Oklahoma County, OK. This novel system incorporates both active and passive elements. The most important factor in conducting our surveillance was the collaboration with CDC and the Oklahoma Commissioner of Health. This allowed us to work with all facilities in the county and collect the required information. We are in the process of better understanding the quality of individual ICD-9 CM codes in identifying

Disclosures

This project was funded by CDC funding: DD14-1407. Dr Bratzler would like to disclose a consultancy for CDC and Sanofi Pasteur. Dr Raskob would like to disclose a consultancy and honoraria for Bayer Healthcare, BMS, Boehringer Ingelheim, Daiichi Sankyo, Janssen Pharmaceuticals, Pfizer, and ISIS Pharmaceuticals. Dr Wendelboe would like to disclose an honoraria from Bristol-Myers Squibb. None of the other authors have any disclosures.

Acknowledgments

This surveillance system was funded by a cooperative agreement with the CDC DD14-1407. We are also deeply grateful for the work of the surveillance officer, Natalie Feland, Aubrey Balch, Jannate Ahmed, Evaren Page, and Ashley Sword-Buster, for their tireless dedication in collecting the data. We are also grateful for Pravina Kota for her information technology support, including the development of the database.

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: CDC disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the CDC.

: Funding provided by a cooperative agreement with CDCDD14-1407.

View full text

Trial DesignThe design and implementation of a new surveillance system for venous thromboembolism using combined active and passive methods

Section snippets

Surveillance system objectives

Results

Discussion

Conclusions

Disclosures

Acknowledgments

Am J Prev Med

Thromb Res

Thromb Res

The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism

The epidemiology of venous thromboembolism in the community

Arterioscler Thromb Vasc Biol

Venous thromboembolism in adult hospitalizations—United States, 2007-2009

MMWR Morb Mortal Wkly Rep

How valid is the ICD-9-CM based AHRQ patient safety indicator for postoperative venous thromboembolism?

Med Care

Improved coding of postoperative deep vein thrombosis and pulmonary embolism in administrative data (AHRQ patient safety indicator 12) after introduction of new ICD-9-CM diagnosis codes

Med Care

A systematic review of validated methods for identifying venous thromboembolism using administrative and claims data

Pharmacoepidemiol Drug Saf

Trial Design
The design and implementation of a new surveillance system for venous thromboembolism using combined active and passive methods