A systematic review of validated methods for identifying transverse myelitis using administrative or claims data

• Limited reports identifying transverse myelitis in administrative data exist.
• Of 47 reports identified through a search strategy, only three met inclusion criteria upon review.
• Algorithms included ICD-9 code combinations 323.8, 323.9, 341.20, 341.21, 341.22.
• Validation of algorithms is not routinely reported, but one found a PPV of 62%.
• Further validation studies are needed to determine the most accurate algorithm.

PurposeTo identify and assess billing, procedural, or diagnostic code algorithms used to identify transverse myelitis in administrative databases.MethodsWe searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to transverse myelitis. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics.ResultsThree studies met criteria for inclusion in this review. The only algorithm based solely on administrative claims data with a reported positive predictive value included five ICD-9 codes (codes 341.20, 341.21, 341.22, 323.8, 323.9). The positive predictive value for physician-diagnosed acute transverse myelitis was 62%.ConclusionsMore research is needed to establish an accurate algorithm to identify transverse myelitis in large administrative databases using diagnosis and/or procedure codes. Use of standardized consensus definitions, clear description for algorithm selection, and reporting of validation procedure and results would be most beneficial.