Development and Validation of a Risk Score for Clostridium difficile Infection in Medicare Beneficiaries: A Population-Based Cohort Study.
Citation: Journal of the American Geriatrics Society. 64(8):1690-5, 2016 AugPMID: 27295521Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Clostridium difficile | *Enterocolitis, Pseudomembranous/di [Diagnosis] | *Enterocolitis, Pseudomembranous/ep [Epidemiology] | *Medicare/sn [Statistics & Numerical Data] | *Risk Assessment/sn [Statistics & Numerical Data] | Age Factors | Aged | Aged, 80 and over | Anti-Ulcer Agents/ad [Administration & Dosage] | Anti-Ulcer Agents/ae [Adverse Effects] | Cohort Studies | Cross-Sectional Studies | Enterocolitis, Pseudomembranous/pc [Prevention & Control] | Female | Humans | Length of Stay/sn [Statistics & Numerical Data] | Male | Retrospective Studies | Sex Factors | United StatesYear: 2016Local holdings: Available online from MWHC library: 1995 - 2000, then 2006-present, Available in print through MWHC library: 1999 - 2006ISSN:- 0002-8614
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 27295521 | Available | 27295521 |
Available online from MWHC library: 1995 - 2000, then 2006-present, Available in print through MWHC library: 1999 - 2006
(c) 2016, Copyright the Authors Journal compilation � 2016, The American Geriatrics Society.
CONCLUSION: CDI risk is high and age dependent in the population aged 65 and older. By stratifying risk, this score should help ensure efficient allocation of prevention resources.
DESIGN: A sample from the Medicare 5% data set linked to Medicaid and Minimum Data Set (MDS) files from 2008 to 2009. Risk score was derived via a split-cohort through logistic regression model used to assign numerical values to each retained covariate. Score characteristics were tested using a threshold analysis.
MEASUREMENTS: The primary outcome was incident CDI, defined as International Classification of Diseases, Ninth Revision, Clinical Modification code 008.45 or CDI according to the MDS, and no CDI in the preceding 12 months.
OBJECTIVES: To create a risk stratification score for Clostridium difficile infection (CDI) in elderly adults.
PARTICIPANTS: Population-based sample Medicare beneficiaries aged 65 and older on January 1, 2008, with continuous Medicare coverage from January 1, 2008, through December 31, 2009.
RESULTS: The cohort consisted of 6,838 participants with CDI and 1,158,327 without. Logistic regression modeling (hospitalization, nursing home stay, or antibiotics in prior year; inflammatory bowel, chronic liver, chronic kidney, or cardiac disease; aged >75, Northeast residence; c-statistic = 0.858) was used to determine to a score out of 22 possible points. A score of seven points (found in 18.8% of the total population) had a negative predictive value of 98.7%.
SETTING: Community, long-term, and acute care settings.
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