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Patompong Ungprasert, MD; Cynthia S. Crowson, MS; Eric L. Matteson, MD, MPH
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FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

aDivision of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN

bDivision of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic College of Medicine and Science, Rochester, MN

cDivision of Epidemiology, Department of Health Science Research, Mayo Clinic College of Medicine and Science, Rochester, MN

dDivision of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

CORRESPONDENCE TO: Patompong Ungprasert, MD, Division of Rheumatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(6):1399. doi:10.1016/j.chest.2017.03.021
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We would like to thank Dr Yaqoob et al for their interest in our study. They performed an analysis to assess the association between sarcoidosis VTE using diagnostic codes from a large electronic medical record database. A significant association between the two conditions was observed at a magnitude similar to that in our report.

There are advantages and drawbacks to both coding-based studies and studies using individual medical record review. A coding-based study using a large database can take advantage of big data to produce more precise effect estimates and can detect small-sized associations. However, the completeness and accuracy of coding are generally limited. A previous study demonstrated a positive predictive value of only 29% for International Classification of Diseases, Ninth Revision, Clinical Modification codes for VTE. In fact, in our cohort, the initial search using diagnostic codes related to sarcoidosis identified 794 patients from the database, but only 345 patients (43%) were confirmed to have sarcoidosis after individual medical record review. Conversely, studies using individual medical record review have limited practicality because of the time needed to access and interrogate the individual medical record. Consequently, the database is generally smaller than that of studies using large administrative data sets, resulting in lower precision and power but much higher diagnostic validation.

It is certainly useful to compare the results of both approaches in assessing associations of interest. If both yield similar results, as appears to be the case in these two studies of the association between sarcoidosis and VTE, it is reasonable to conclude that the observed association is the true association.

References

Ungprasert P. .Crowson C.S. .Matteson E.L. . Association of sarcoidosis with increased risk of VTE: a population-based study, 1976 to 2013. Chest. 2017;151:425-430 [PubMed]journal. [CrossRef] [PubMed]
 
O’Malley K.J. .Cook K.F. .Price M.D. .Wildes K.R. .Hurdle J.F. .Ashton C.M. . Measuring diagnoses: ICD code accuracy. Health Serv Res. 2005;40:1620-1639 [PubMed]journal. [CrossRef] [PubMed]
 
Zhan C. .Battles J. .Chiang Y.P. .Hunt D. . The validity of ICD-9-CM codes in identifying postoperative deep vein thrombosis and pulmonary embolism. Jt Comm J Qual Patient Saf. 2007;33:326-331 [PubMed]journal. [CrossRef] [PubMed]
 
Ungprasert P. .Carmona E.M. .Utz J.P. .Ryu J.H. .Crowson C.S. .Matteson E.L. . Epidemiology of sarcoidosis 1946-2013: a population-based study. Mayo Clin Proc. 2016;91:183-188 [PubMed]journal. [CrossRef] [PubMed]
 

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Tables

References

Ungprasert P. .Crowson C.S. .Matteson E.L. . Association of sarcoidosis with increased risk of VTE: a population-based study, 1976 to 2013. Chest. 2017;151:425-430 [PubMed]journal. [CrossRef] [PubMed]
 
O’Malley K.J. .Cook K.F. .Price M.D. .Wildes K.R. .Hurdle J.F. .Ashton C.M. . Measuring diagnoses: ICD code accuracy. Health Serv Res. 2005;40:1620-1639 [PubMed]journal. [CrossRef] [PubMed]
 
Zhan C. .Battles J. .Chiang Y.P. .Hunt D. . The validity of ICD-9-CM codes in identifying postoperative deep vein thrombosis and pulmonary embolism. Jt Comm J Qual Patient Saf. 2007;33:326-331 [PubMed]journal. [CrossRef] [PubMed]
 
Ungprasert P. .Carmona E.M. .Utz J.P. .Ryu J.H. .Crowson C.S. .Matteson E.L. . Epidemiology of sarcoidosis 1946-2013: a population-based study. Mayo Clin Proc. 2016;91:183-188 [PubMed]journal. [CrossRef] [PubMed]
 
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