Diagnostic validation and development of an algorithm for identification of intussusception in children using electronic health records of Ningbo city in China

ABSTRACT

Background

Monitoring the risk of intussusception after the introduction of rotavirus vaccines is recommended by the World Health Organization (WHO). Although the validity of intussusception monitoring using electronic health records (EHRs) has been confirmed previously, no similar studies have been conducted in China. We aimed to verify the diagnosis and determine an algorithm with the best performance for identification of intussusception using Chinese EHR databases.

Research design and methods

Using the Regional Health Information Platform in Ningbo, patients aged 0–72 months from 2015 to 2021 with any related visits for intussusception were included. The algorithms were based on diagnostic codes or keywords in different clinical scenarios, and their performance was evaluated with positive predictive value (PPV) and sensitivity in line with the Brighton guidelines.

Results

Brighton level 1 intussusception was confirmed in 2958 patients with 3246 episodes. Fine-tuned algorithms combining the appearance of the relevant ICD-10 codes or the Chinese keyword ‘Chang Tao’ in any diagnostic reports with the results of enema treatments or related surgeries showed the highest sensitivity, while the highest PPV was obtained by further criteria based on typical radiographic appearances.

Conclusion

Intussusception could be identified and validated internally using EHRs in Ningbo.

KEYWORDS:

• Algorithms
• China
• electronic health records
• intussusception
• post-market monitoring
• verification study

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

S. Zhan and G. Xu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. S. Deng, Z. Liu are co–first authors. Concept and design: S. Deng, Z. Liu, S. Zhan. Acquisition, analysis, or interpretation of data: S. Deng, Z. Liu, J. Yang, L. Zhang, R. Ma, N. Li, G. Xu.

Drafting of the manuscript: S. Deng, Z. Liu. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: S. Deng, Z. Liu, J. Yang.

Obtained funding: S. Zhan. Administrative, technical, or material support: T. Shou, J. Zhu, Y. He. Supervision: Z. Liu, G. Xu, S. Zhan. Final approval of manuscript: all authors.

Ethics approval and patient consent

The study protocol was approved by the ethical review committee of the Peking University Health Science Center (IRB. No: IRB00001052-15, 045). The requirement for informed consent was waived.

Data availability statement

The data that support the findings of this study are from the Ningbo Center for Disease Control and Prevention, but are not publicly available due to privacy or ethical restrictions. Data are available on request from the corresponding author and with permission of Ningbo Center for Disease Control and Prevention.

Additional information

Funding

This manuscript was funded by the National Natural Science Foundation of China (grant number 81973146), the National Natural Science Foundation of China for young scholars (grant number 82204175), and the National Key Research and Development Project of China (grant number 2016YFC0901105). This work was also supported in part by the Bill & Melinda Gates Foundation (grant number INV-035024). Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. The funders had no role in study design, data collection, analysis, and preparation of the manuscript.