Reviewer's report
Title:Validation of coding algorithms for the identification of patients hospitalized
for alcoholic hepatitis using administrative data
Version:1Date:1 March 2015
Reviewer: Peter Jepsen
Reviewer's report:
Pang et al. have examined the coding accuracy of ICD10 diagnoses of alcoholic
hepatitis (AH). This is an important topic, and the manuscript is very well written.
My main concern is that I need to understand WHY the PPV of the AH code is so
low.
* As it is said in the introduction, AH is clinical syndrome characterized by rapid
onset og jaundice following heavy alcohol intake. No other signs and symptoms
are required, except that it is necessary to rule out other causes of jaundice. So,
despite the claim that the diagnostic criteria are lenient, they may still be too
strict. Personally, I think that normal AST/ALT and INR are perfectly compatible
with a diagnosis of AH, and smaller alcohol amounts can also cause AH. It would
be very informative if you could also present the PPV with less strict criteria for
AH.
* Most importantly, readers need to know the correct diagnosis in the patients
who did in fact not have AH. In my experience, decompensated cirrhosis,
infection, gallstone disease, and other causes of acute hepatitis are the most
common differential diagnoses. What proportion of patients had these diseases?
Or were the wrong AH diagnoses in fact random typos, and patients had a
disease that does not at all resemble AH?
* There must have been some patients who were described in the medical
records as having "obvious AH", or something to that effect. How were such
patients handled if they did not fulfill your diagnostic criteria? Remember that AH
is a CLINICAL SYNDROME, and you can't see the patient!
* You had three different investigators examine each of 21 patients to assess
inter-rater agreement. But what was there to disagree about, considering your
explicit diagnostic criteria?
* On page 8, top, it is quite confusing that you mention the UNconfirmed cases
first in the parentheses.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests'
Reviewer's report
Title:Validation of coding algorithms for the identification of patients hospitalized
for alcoholic hepatitis using administrative data
Version:1Date:1 March 2015
Reviewer: Peter Jepsen
Reviewer's report:
Pang et al. have examined the coding accuracy of ICD10 diagnoses of alcoholic
hepatitis (AH). This is an important topic, and the manuscript is very well written.
My main concern is that I need to understand WHY the PPV of the AH code is so
low.
* As it is said in the introduction, AH is clinical syndrome characterized by rapid
onset og jaundice following heavy alcohol intake. No other signs and symptoms
are required, except that it is necessary to rule out other causes of jaundice. So,
despite the claim that the diagnostic criteria are lenient, they may still be too
strict. Personally, I think that normal AST/ALT and INR are perfectly compatible
with a diagnosis of AH, and smaller alcohol amounts can also cause AH. It would
be very informative if you could also present the PPV with less strict criteria for
AH.
* Most importantly, readers need to know the correct diagnosis in the patients
who did in fact not have AH. In my experience, decompensated cirrhosis,
infection, gallstone disease, and other causes of acute hepatitis are the most
common differential diagnoses. What proportion of patients had these diseases?
Or were the wrong AH diagnoses in fact random typos, and patients had a
disease that does not at all resemble AH?
* There must have been some patients who were described in the medical
records as having "obvious AH", or something to that effect. How were such
patients handled if they did not fulfill your diagnostic criteria? Remember that AH
is a CLINICAL SYNDROME, and you can't see the patient!
* You had three different investigators examine each of 21 patients to assess
inter-rater agreement. But what was there to disagree about, considering your
explicit diagnostic criteria?
* On page 8, top, it is quite confusing that you mention the UNconfirmed cases
first in the parentheses.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:Validation of coding algorithms for the identification of patients hospitalized
for alcoholic hepatitis using administrative data
Version:1Date:1 March 2015
Reviewer: Peter Jepsen
Reviewer's report:
Pang et al. have examined the coding accuracy of ICD10 diagnoses of alcoholic
hepatitis (AH). This is an important topic, and the manuscript is very well written.
My main concern is that I need to understand WHY the PPV of the AH code is so
low.
* As it is said in the introduction, AH is clinical syndrome characterized by rapid
onset og jaundice following heavy alcohol intake. No other signs and symptoms
are required, except that it is necessary to rule out other causes of jaundice. So,
despite the claim that the diagnostic criteria are lenient, they may still be too
strict. Personally, I think that normal AST/ALT and INR are perfectly compatible
with a diagnosis of AH, and smaller alcohol amounts can also cause AH. It would
be very informative if you could also present the PPV with less strict criteria for
AH.
* Most importantly, readers need to know the correct diagnosis in the patients
who did in fact not have AH. In my experience, decompensated cirrhosis,
infection, gallstone disease, and other causes of acute hepatitis are the most
common differential diagnoses. What proportion of patients had these diseases?
Or were the wrong AH diagnoses in fact random typos, and patients had a
disease that does not at all resemble AH?
* There must have been some patients who were described in the medical
records as having "obvious AH", or something to that effect. How were such
patients handled if they did not fulfill your diagnostic criteria? Remember that AH
is a CLINICAL SYNDROME, and you can't see the patient!
* You had three different investigators examine each of 21 patients to assess
inter-rater agreement. But what was there to disagree about, considering your
explicit diagnostic criteria?
* On page 8, top, it is quite confusing that you mention the UNconfirmed cases
first in the parentheses.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests'
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