Evidence map›Paper›PMID 34266920›Full record

ArticleNeurology2021

Definitions of Drug-Resistant Epilepsy for Administrative Claims Data Research.

Chloe E Hill, Chun Chieh Lin, Samuel W Terman, Subhendu Rath, Jack M Parent, Lesli E Skolarus, James F Burke

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Chloe E HillFrom the Health Services Research Program (C.E.H., C.C.L., S.W.T., L.E.S., J.F.B.), Department of Neurology, University of Michigan; Department of Neurology (S.R., J.M.P.), University of Michigan; Veterans Affairs Healthcare System (J.M.P., J.F.B.); and Michigan Neuroscience Institute (J.M.P.), Ann Arbor. chloehi@med.umich.edu.
Chun Chieh LinFrom the Health Services Research Program (C.E.H., C.C.L., S.W.T., L.E.S., J.F.B.), Department of Neurology, University of Michigan; Department of Neurology (S.R., J.M.P.), University of Michigan; Veterans Affairs Healthcare System (J.M.P., J.F.B.); and Michigan Neuroscience Institute (J.M.P.), Ann Arbor.
Samuel W TermanFrom the Health Services Research Program (C.E.H., C.C.L., S.W.T., L.E.S., J.F.B.), Department of Neurology, University of Michigan; Department of Neurology (S.R., J.M.P.), University of Michigan; Veterans Affairs Healthcare System (J.M.P., J.F.B.); and Michigan Neuroscience Institute (J.M.P.), Ann Arbor.
Subhendu RathFrom the Health Services Research Program (C.E.H., C.C.L., S.W.T., L.E.S., J.F.B.), Department of Neurology, University of Michigan; Department of Neurology (S.R., J.M.P.), University of Michigan; Veterans Affairs Healthcare System (J.M.P., J.F.B.); and Michigan Neuroscience Institute (J.M.P.), Ann Arbor.
Jack M ParentFrom the Health Services Research Program (C.E.H., C.C.L., S.W.T., L.E.S., J.F.B.), Department of Neurology, University of Michigan; Department of Neurology (S.R., J.M.P.), University of Michigan; Veterans Affairs Healthcare System (J.M.P., J.F.B.); and Michigan Neuroscience Institute (J.M.P.), Ann Arbor.
Lesli E SkolarusFrom the Health Services Research Program (C.E.H., C.C.L., S.W.T., L.E.S., J.F.B.), Department of Neurology, University of Michigan; Department of Neurology (S.R., J.M.P.), University of Michigan; Veterans Affairs Healthcare System (J.M.P., J.F.B.); and Michigan Neuroscience Institute (J.M.P.), Ann Arbor.
James F BurkeFrom the Health Services Research Program (C.E.H., C.C.L., S.W.T., L.E.S., J.F.B.), Department of Neurology, University of Michigan; Department of Neurology (S.R., J.M.P.), University of Michigan; Veterans Affairs Healthcare System (J.M.P., J.F.B.); and Michigan Neuroscience Institute (J.M.P.), Ann Arbor.

Funding

Institutional Career Development CoreKL2TR002241 · NCATS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI ELLINGROD, VICKI L · 2017 to 2021
$6.9M
NCATS NIH HHS KL2 TR002241
6 · The paper itself

Abstract

BACKGROUND AND

objectiveTo assess the accuracy of definitions of drug-resistant epilepsy applied to administrative claims data.

methodsWe randomly sampled 450 patients from a tertiary health system with ≥1 epilepsy/convulsion encounter, ≥2 distinct antiseizure medications (ASMs) from 2014 to 2020, and ≥2 years of electronic medical records (EMR) data. We established a drug-resistant epilepsy diagnosis at a specific visit by reviewing EMR data and using a rubric based on the 2010 International League Against Epilepsy definition. We performed logistic regressions to assess clinically relevant predictors of drug-resistant epilepsy and to inform claims-based definitions.

resultsOf 450 patients reviewed, 150 were excluded for insufficient EMR data. Of the 300 patients included, 98 (33%) met criteria for current drug-resistant epilepsy. The strongest predictors of current drug-resistant epilepsy were drug-resistant epilepsy diagnosis code (odds ratio [OR] 16.9, 95% confidence interval [CI] 8.8-32.2), ≥2 ASMs in the prior 2 years (OR 13.0, 95% CI 5.1-33.3), ≥3 nongabapentinoid ASMs (OR 10.3, 95% CI 5.4-19.6), neurosurgery visit (OR 45.2, 95% CI 5.9-344.3), and epilepsy surgery (OR 30.7, 95% CI 7.1-133.3). We created claims-based drug-resistant epilepsy definitions (1) to maximize overall predictiveness (drug-resistant epilepsy diagnosis; sensitivity 0.86, specificity 0.74, area under the receiver operating characteristics curve [AUROC] 0.80), (2) to maximize sensitivity (drug-resistant epilepsy diagnosis or ≥3 ASMs; sensitivity 0.98, specificity 0.47, AUROC 0.72), and (3) to maximize specificity (drug-resistant epilepsy diagnosis and ≥3 nongabapentinoid ASMs; sensitivity 0.42, specificity 0.98, AUROC 0.70). DISCUSSION: Our findings provide validation for several claims-based definitions of drug-resistant epilepsy that can be applied to a variety of research questions.

Indexed as

Administrative Claims, HealthcareDrug Resistant EpilepsyHumans

Identifiers

PMID34266920
PMCPMC8480406

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.