Validity of Methods to Identify Individuals With Lower Extremity Amputation Using Department of Veterans Affairs Electronic Medical Records.
Morgan Meadows, Alexander Peterson, Edward J Boyko and 1 others
PMID 35282148WHAT IT FOUND
A single lower-extremity amputation code in Veterans Affairs records often correctly identified men but wrongly flagged many women.
Requiring more than one code or ignoring single status codes correctly identified more people, though it missed some amputations.
Key findings
01Using only one amputation code correctly identified 89% of flagged patients overall, but it correctly identified only 55% of flagged women.
02Requiring at least one procedure code or two or more diagnosis codes, or excluding single status codes, correctly identified 98% of flagged patients and missed 2% of self-reported amputations.
03The single-code method performed differently by sex, with 55% correct among women and 92% correct among men.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study only looked at people who already had at least one amputation code, so it could not measure how well the codes find amputations in people without codes. Most eligible people with codes were men (98%), and women were oversampled, so the results may not reflect populations outside the VA. Only 68% of eligible contacted people answered the survey, and responders and nonresponders differed by age, sex, and race. The reference standard was self-report by mail or phone, not medical record review or physical exam. Many respondents had no procedure code (78%), likely because their amputation was done outside the VA, so procedure-code rules missed amputations performed elsewhere. The authors said it is not known whether the findings apply outside the VA.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that a single amputation code reliably identifies a patient. In this sample, only 55% of women flagged by one code self-reported an amputation, and stricter code rules missed some true amputations.