Abstract
Background: Increasing epidemiologic and intervention research is being conducted on opioid overdose, a serious and potentially fatal outcome. However, there is little consensus on how to verify opioid overdose outcomes for research purposes. To ensure reproducibility, minimize misclassification, and permit data harmonization across studies, standardized and consistent overdose definitions are needed. The aims were to develop a case criteria classification scheme based on information commonly available in medical records and to compare it with reviewing physician clinical impression and simple encounter documentation. Methods: In 2 large health systems, we developed a case criteria classification scheme for opioid overdose based on prior literature, expert opinion, and pilot testing with sample medical records. We then identified emergency department and hospital encounters (n = 259) with at least 1 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code representing a broad range of opioid and non-opioid related poisonings. Physicians conducted structured medical record reviews to identify the proposed case criteria and generate a clinical impression, and trained abstractors verified documentation. We then compared the case criteria classification scheme with clinical impression and encounter documentation. Results: We developed a quantitative opioid overdose case criteria classification scheme that included 3 sets of major criteria and 9 minor criteria (supporting documentation). For the encounters identified using poisoning codes, the proportion verified as opioid overdoses using the case criteria classification scheme, clinical impression, and encounter documentation ranged from 50.4% to 52.7% at one site and 55.5% to 67.2% at the second site. Discrepancies across approaches and sites related to differences in available records and documentation of clinical signs of overdose. Conclusions: We propose a novel case criteria classification scheme for opioid overdose that could be used to rigorously and consistently define overdose across multiple research settings. However, prior to widespread use, further refinement and validation are needed.
Correction Statement
This article has been republished with minor changes. These changes do not impact the academic content of the article.
Acknowledgments
We wish to thank Shane Mueller, MSW, for project coordination and data collection; Ted Palen, MD, PhD, Ruth Bedoy, and Melanie Stowell, MSc, for data collection; Kerry Broderick, MD, Jason Hoppe, DO, Joseph Frank, MD, MPH, and Andrew Monte, MD, for providing expertise and feedback on overdose definitions; and Kristin Breslin, MS, for providing data and analysis assistance.
Additional information
Funding
Notes on contributors
Ingrid A. Binswanger
I.A.B. conceived of the study and design, collected data, interpreted results, and wrote the manuscript. K.J.N. assisted with research design, analysis, and revision of the manuscript. E.M.G. collected data and revised the manuscript. B.A.G. participated in conception of the study and revising the manuscript. S.C. assisted with data collection and manuscript revisions. J.M.G. conceived of the study design, interpreted results, and revised the manuscript.
Komal J. Narwaney
I.A.B. conceived of the study and design, collected data, interpreted results, and wrote the manuscript. K.J.N. assisted with research design, analysis, and revision of the manuscript. E.M.G. collected data and revised the manuscript. B.A.G. participated in conception of the study and revising the manuscript. S.C. assisted with data collection and manuscript revisions. J.M.G. conceived of the study design, interpreted results, and revised the manuscript.
Edward M. Gardner
I.A.B. conceived of the study and design, collected data, interpreted results, and wrote the manuscript. K.J.N. assisted with research design, analysis, and revision of the manuscript. E.M.G. collected data and revised the manuscript. B.A.G. participated in conception of the study and revising the manuscript. S.C. assisted with data collection and manuscript revisions. J.M.G. conceived of the study design, interpreted results, and revised the manuscript.
Barbara A. Gabella
I.A.B. conceived of the study and design, collected data, interpreted results, and wrote the manuscript. K.J.N. assisted with research design, analysis, and revision of the manuscript. E.M.G. collected data and revised the manuscript. B.A.G. participated in conception of the study and revising the manuscript. S.C. assisted with data collection and manuscript revisions. J.M.G. conceived of the study design, interpreted results, and revised the manuscript.
Susan L. Calcaterra
I.A.B. conceived of the study and design, collected data, interpreted results, and wrote the manuscript. K.J.N. assisted with research design, analysis, and revision of the manuscript. E.M.G. collected data and revised the manuscript. B.A.G. participated in conception of the study and revising the manuscript. S.C. assisted with data collection and manuscript revisions. J.M.G. conceived of the study design, interpreted results, and revised the manuscript.
Jason M. Glanz
I.A.B. conceived of the study and design, collected data, interpreted results, and wrote the manuscript. K.J.N. assisted with research design, analysis, and revision of the manuscript. E.M.G. collected data and revised the manuscript. B.A.G. participated in conception of the study and revising the manuscript. S.C. assisted with data collection and manuscript revisions. J.M.G. conceived of the study design, interpreted results, and revised the manuscript.