Pulse dose steroid experience among hospitalized patients with systemic lupus erythematosus: a single-center feasibility study
Introduction/objectives: Pulse intravenous (IV) methylprednisolone (MEP) is often used for severe SLE manifestations requiring hospitalization. However, the accuracy of pulse dose documentation extracted from the electronic health record (EHR) is unknown. We assessed the feasibility to study pulse s...
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| Published in: | Clinical rheumatology Vol. 40; no. 4; pp. 1317 - 1320 |
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| Main Authors: | , , |
| Format: | Journal Article |
| Language: | English |
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Springer International Publishing
01.04.2021
Springer Nature B.V |
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| ISSN: | 0770-3198, 1434-9949, 1434-9949 |
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| Abstract | Introduction/objectives: Pulse intravenous (IV) methylprednisolone (MEP) is often used for severe SLE manifestations requiring hospitalization. However, the accuracy of pulse dose documentation extracted from the electronic health record (EHR) is unknown. We assessed the feasibility to study pulse steroid dosing among hospitalized patients with SLE at our institution. Method: Using the Stanford Medicine Research Data Repository (STARR) extracted from the EHR, we identified patients with ≥ 1 SLE ICD code before/during hospitalization receiving steroids (1/2008-12/2017). SLE diagnosis required rheumatologist confirmation. For our feasibility study, we randomly sampled 40/747 patients meeting search criteria. Pulse IV MEP was defined as ≥ 200 mg. Pharmacy dispensation data required EHR confirmation. Results: Forty adult and pediatric subjects were identified, passing initial criteria screen; 6 pediatric patients were excluded as EHR pharmacy confirmation was unavailable. Of the 34 adults, 14 had SLE confirmed. Among 5 adult SLE patients with pulse documentation, 3 occurred while hospitalized, for the following indications: acute renal transplant rejection (2 patients, 2 hospitalizations) and lupus flare (1 patient, 2 hospitalizations). No discrepancies were observed in pharmacy dispensation documentation of pulse dosing between EHR and STARR for all 4 hospitalizations. Conclusions: Assessment of pulse steroid dose dispensation among hospitalized patients with SLE can be reliably ascertained from the extracted portion of the EHR designed for research. Reliance on a single ICD code for SLE in the EHR may lead to high rate of false-positive diagnoses of SLE among hospitalized patients. We document the importance of supplementing one ICD code with additional clinical information when confirming SLE diagnosis.
Key Points
• Assessment of pulse steroid dosing dispensation among hospitalized patients with SLE can be reliably determined from the extracted portion of the EHR designed for research purposes.
• Reliance on a single ICD code contributes to a high rate of false positive diagnoses of SLE among hospitalized patients.
• Supplementing ICD coding with additional clinical information is vital when confirming SLE diagnosis. |
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| AbstractList | Introduction/objectives: Pulse intravenous (IV) methylprednisolone (MEP) is often used for severe SLE manifestations requiring hospitalization. However, the accuracy of pulse dose documentation extracted from the electronic health record (EHR) is unknown. We assessed the feasibility to study pulse steroid dosing among hospitalized patients with SLE at our institution. Method: Using the Stanford Medicine Research Data Repository (STARR) extracted from the EHR, we identified patients with ≥ 1 SLE ICD code before/during hospitalization receiving steroids (1/2008-12/2017). SLE diagnosis required rheumatologist confirmation. For our feasibility study, we randomly sampled 40/747 patients meeting search criteria. Pulse IV MEP was defined as ≥ 200 mg. Pharmacy dispensation data required EHR confirmation. Results: Forty adult and pediatric subjects were identified, passing initial criteria screen; 6 pediatric patients were excluded as EHR pharmacy confirmation was unavailable. Of the 34 adults, 14 had SLE confirmed. Among 5 adult SLE patients with pulse documentation, 3 occurred while hospitalized, for the following indications: acute renal transplant rejection (2 patients, 2 hospitalizations) and lupus flare (1 patient, 2 hospitalizations). No discrepancies were observed in pharmacy dispensation documentation of pulse dosing between EHR and STARR for all 4 hospitalizations. Conclusions: Assessment of pulse steroid dose dispensation among hospitalized patients with SLE can be reliably ascertained from the extracted portion of the EHR designed for research. Reliance on a single ICD code for SLE in the EHR may lead to high rate of false-positive diagnoses of SLE among hospitalized patients. We document the importance of supplementing one ICD code with additional clinical information when confirming SLE diagnosis.
Key Points
• Assessment of pulse steroid dosing dispensation among hospitalized patients with SLE can be reliably determined from the extracted portion of the EHR designed for research purposes.
• Reliance on a single ICD code contributes to a high rate of false positive diagnoses of SLE among hospitalized patients.
• Supplementing ICD coding with additional clinical information is vital when confirming SLE diagnosis. Pulse intravenous (IV) methylprednisolone (MEP) is often used for severe SLE manifestations requiring hospitalization. However, the accuracy of pulse dose documentation extracted from the electronic health record (EHR) is unknown. We assessed the feasibility to study pulse steroid dosing among hospitalized patients with SLE at our institution.INTRODUCTION/OBJECTIVESPulse intravenous (IV) methylprednisolone (MEP) is often used for severe SLE manifestations requiring hospitalization. However, the accuracy of pulse dose documentation extracted from the electronic health record (EHR) is unknown. We assessed the feasibility to study pulse steroid dosing among hospitalized patients with SLE at our institution. Using the Stanford Medicine Research Data Repository (STARR) extracted from the EHR, we identified patients with ≥ 1 SLE ICD code before/during hospitalization receiving steroids (1/2008-12/2017). SLE diagnosis required rheumatologist confirmation. For our feasibility study, we randomly sampled 40/747 patients meeting search criteria. Pulse IV MEP was defined as ≥ 200 mg. Pharmacy dispensation data required EHR confirmation.METHOD Using the Stanford Medicine Research Data Repository (STARR) extracted from the EHR, we identified patients with ≥ 1 SLE ICD code before/during hospitalization receiving steroids (1/2008-12/2017). SLE diagnosis required rheumatologist confirmation. For our feasibility study, we randomly sampled 40/747 patients meeting search criteria. Pulse IV MEP was defined as ≥ 200 mg. Pharmacy dispensation data required EHR confirmation. Forty adult and pediatric subjects were identified, passing initial criteria screen; 6 pediatric patients were excluded as EHR pharmacy confirmation was unavailable. Of the 34 adults, 14 had SLE confirmed. Among 5 adult SLE patients with pulse documentation, 3 occurred while hospitalized, for the following indications: acute renal transplant rejection (2 patients, 2 hospitalizations) and lupus flare (1 patient, 2 hospitalizations). No discrepancies were observed in pharmacy dispensation documentation of pulse dosing between EHR and STARR for all 4 hospitalizations.RESULTS Forty adult and pediatric subjects were identified, passing initial criteria screen; 6 pediatric patients were excluded as EHR pharmacy confirmation was unavailable. Of the 34 adults, 14 had SLE confirmed. Among 5 adult SLE patients with pulse documentation, 3 occurred while hospitalized, for the following indications: acute renal transplant rejection (2 patients, 2 hospitalizations) and lupus flare (1 patient, 2 hospitalizations). No discrepancies were observed in pharmacy dispensation documentation of pulse dosing between EHR and STARR for all 4 hospitalizations.Assessment of pulse steroid dose dispensation among hospitalized patients with SLE can be reliably ascertained from the extracted portion of the EHR designed for research. Reliance on a single ICD code for SLE in the EHR may lead to high rate of false-positive diagnoses of SLE among hospitalized patients. We document the importance of supplementing one ICD code with additional clinical information when confirming SLE diagnosis. Key Points • Assessment of pulse steroid dosing dispensation among hospitalized patients with SLE can be reliably determined from the extracted portion of the EHR designed for research purposes. • Reliance on a single ICD code contributes to a high rate of false positive diagnoses of SLE among hospitalized patients. • Supplementing ICD coding with additional clinical information is vital when confirming SLE diagnosis.CONCLUSIONSAssessment of pulse steroid dose dispensation among hospitalized patients with SLE can be reliably ascertained from the extracted portion of the EHR designed for research. Reliance on a single ICD code for SLE in the EHR may lead to high rate of false-positive diagnoses of SLE among hospitalized patients. We document the importance of supplementing one ICD code with additional clinical information when confirming SLE diagnosis. Key Points • Assessment of pulse steroid dosing dispensation among hospitalized patients with SLE can be reliably determined from the extracted portion of the EHR designed for research purposes. • Reliance on a single ICD code contributes to a high rate of false positive diagnoses of SLE among hospitalized patients. • Supplementing ICD coding with additional clinical information is vital when confirming SLE diagnosis. Introduction/objectives: Pulse intravenous (IV) methylprednisolone (MEP) is often used for severe SLE manifestations requiring hospitalization. However, the accuracy of pulse dose documentation extracted from the electronic health record (EHR) is unknown. We assessed the feasibility to study pulse steroid dosing among hospitalized patients with SLE at our institution. Method: Using the Stanford Medicine Research Data Repository (STARR) extracted from the EHR, we identified patients with ≥ 1 SLE ICD code before/during hospitalization receiving steroids (1/2008-12/2017). SLE diagnosis required rheumatologist confirmation. For our feasibility study, we randomly sampled 40/747 patients meeting search criteria. Pulse IV MEP was defined as ≥ 200 mg. Pharmacy dispensation data required EHR confirmation. Results: Forty adult and pediatric subjects were identified, passing initial criteria screen; 6 pediatric patients were excluded as EHR pharmacy confirmation was unavailable. Of the 34 adults, 14 had SLE confirmed. Among 5 adult SLE patients with pulse documentation, 3 occurred while hospitalized, for the following indications: acute renal transplant rejection (2 patients, 2 hospitalizations) and lupus flare (1 patient, 2 hospitalizations). No discrepancies were observed in pharmacy dispensation documentation of pulse dosing between EHR and STARR for all 4 hospitalizations. Conclusions: Assessment of pulse steroid dose dispensation among hospitalized patients with SLE can be reliably ascertained from the extracted portion of the EHR designed for research. Reliance on a single ICD code for SLE in the EHR may lead to high rate of false-positive diagnoses of SLE among hospitalized patients. We document the importance of supplementing one ICD code with additional clinical information when confirming SLE diagnosis.Key Points• Assessment of pulse steroid dosing dispensation among hospitalized patients with SLE can be reliably determined from the extracted portion of the EHR designed for research purposes.• Reliance on a single ICD code contributes to a high rate of false positive diagnoses of SLE among hospitalized patients.• Supplementing ICD coding with additional clinical information is vital when confirming SLE diagnosis. Pulse intravenous (IV) methylprednisolone (MEP) is often used for severe SLE manifestations requiring hospitalization. However, the accuracy of pulse dose documentation extracted from the electronic health record (EHR) is unknown. We assessed the feasibility to study pulse steroid dosing among hospitalized patients with SLE at our institution. Using the Stanford Medicine Research Data Repository (STARR) extracted from the EHR, we identified patients with ≥ 1 SLE ICD code before/during hospitalization receiving steroids (1/2008-12/2017). SLE diagnosis required rheumatologist confirmation. For our feasibility study, we randomly sampled 40/747 patients meeting search criteria. Pulse IV MEP was defined as ≥ 200 mg. Pharmacy dispensation data required EHR confirmation. Forty adult and pediatric subjects were identified, passing initial criteria screen; 6 pediatric patients were excluded as EHR pharmacy confirmation was unavailable. Of the 34 adults, 14 had SLE confirmed. Among 5 adult SLE patients with pulse documentation, 3 occurred while hospitalized, for the following indications: acute renal transplant rejection (2 patients, 2 hospitalizations) and lupus flare (1 patient, 2 hospitalizations). No discrepancies were observed in pharmacy dispensation documentation of pulse dosing between EHR and STARR for all 4 hospitalizations. Assessment of pulse steroid dose dispensation among hospitalized patients with SLE can be reliably ascertained from the extracted portion of the EHR designed for research. Reliance on a single ICD code for SLE in the EHR may lead to high rate of false-positive diagnoses of SLE among hospitalized patients. We document the importance of supplementing one ICD code with additional clinical information when confirming SLE diagnosis. Key Points • Assessment of pulse steroid dosing dispensation among hospitalized patients with SLE can be reliably determined from the extracted portion of the EHR designed for research purposes. • Reliance on a single ICD code contributes to a high rate of false positive diagnoses of SLE among hospitalized patients. • Supplementing ICD coding with additional clinical information is vital when confirming SLE diagnosis. |
| Author | Weisman, Michael H. Chaichian, Yashaar Simard, Julia F. |
| Author_xml | – sequence: 1 givenname: Yashaar orcidid: 0000-0002-2231-3900 surname: Chaichian fullname: Chaichian, Yashaar email: ychaich@stanford.edu organization: Division of Immunology and Rheumatology, Stanford University – sequence: 2 givenname: Michael H. orcidid: 0000-0001-5568-388X surname: Weisman fullname: Weisman, Michael H. organization: Division of Immunology and Rheumatology, Stanford University – sequence: 3 givenname: Julia F. orcidid: 0000-0001-5735-9856 surname: Simard fullname: Simard, Julia F. organization: Division of Immunology and Rheumatology, Stanford University, Department of Epidemiology & Population Health, Stanford University |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33608793$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.3899/jrheum.170072 10.1002/acr.20184 10.1136/annrheumdis-2013-205171 10.1136/lupus-2017-000249 10.1002/art.1780400928 10.1002/1529-0131(199912)42:12<2682::AID-ANR26>3.0.CO;2-6 10.1002/acr.22989 10.1016/j.vaccine.2013.06.104 10.1177/0961203318817132 10.1093/rheumatology/kes391 10.1002/art.34473 10.1136/ard.61.8.718 10.1177/0961203317731534 |
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A 10-year, inception cohort study publication-title: Lupus doi: 10.1177/0961203317731534 – volume: 31 start-page: K62 issue: Suppl 10 year: 2013 ident: 5644_CR13 publication-title: Vaccine doi: 10.1016/j.vaccine.2013.06.104 – volume: 27 start-page: 556 issue: 4 year: 2018 ident: 5644_CR5 publication-title: Lupus doi: 10.1177/0961203317731534 – volume: 61 start-page: 718 issue: 8 year: 2002 ident: 5644_CR9 publication-title: Ann Rheum Dis doi: 10.1136/ard.61.8.718 – volume: 44 start-page: 1173 issue: 8 year: 2017 ident: 5644_CR7 publication-title: J Rheumatol doi: 10.3899/jrheum.170072 – volume: 5 issue: 1 year: 2018 ident: 5644_CR8 publication-title: Lupus Sci Med doi: 10.1136/lupus-2017-000249 – volume: 2009 start-page: 391 year: 2009 ident: 5644_CR10 publication-title: AMIA Annu Symp Proc – volume: 74 start-page: 1706 issue: 9 year: 2015 ident: 5644_CR4 publication-title: Ann Rheum Dis doi: 10.1136/annrheumdis-2013-205171 – volume: 64 start-page: 2677 issue: 8 year: 2012 ident: 5644_CR12 publication-title: Arthritis Rheum doi: 10.1002/art.34473 – volume: 28 start-page: 114 issue: 1 year: 2019 ident: 5644_CR3 publication-title: Lupus doi: 10.1177/0961203318817132 – volume: 52 start-page: 905 issue: 5 year: 2013 ident: 5644_CR6 publication-title: Rheumatology (Oxford) doi: 10.1093/rheumatology/kes391 – volume: 42 start-page: 2682 issue: 12 year: 1999 ident: 5644_CR2 publication-title: Arthritis Rheum doi: 10.1002/1529-0131(199912)42:12<2682::AID-ANR26>3.0.CO;2-6 – volume: 56 start-page: i3 issue: suppl_1 year: 2017 ident: 5644_CR1 publication-title: Rheumatology (Oxford) – volume: 40 start-page: 1725 issue: 9 year: 1997 ident: 5644_CR11 publication-title: Arthritis Rheum doi: 10.1002/art.1780400928 – volume: 69 start-page: 687 issue: 5 year: 2017 ident: 5644_CR15 publication-title: Arthritis Care Res doi: 10.1002/acr.22989 – volume: 62 start-page: 1120 issue: 8 year: 2010 ident: 5644_CR14 publication-title: Arthritis Care Res doi: 10.1002/acr.20184 |
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| Title | Pulse dose steroid experience among hospitalized patients with systemic lupus erythematosus: a single-center feasibility study |
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