A systematic review of the Charlson comorbidity index using Canadian administrative databases: A perspective on risk adjustment in critical care research

Dale Needham, Damon C. Scales, Andreas Laupacis, Peter J. Pronovost

Research output: Contribution to journalArticle

Abstract

The Charlson index is commonly used for risk adjustment in critical care health services research. However, the literature supporting this methodology has not been thoroughly explored. We systematically reviewed the literature related to administrative database adaptations of the Charlson index. Our review has 3 major findings. First, 2 studies compared Canadian administrative databases with chart review for obtaining Charlson comorbidity data. Agreement between the database and chart review was substantial (κ > 0.70), and mortality prediction did not differ. Second, 5 database adaptations were identified with the Deyo and Dartmouth-Manitoba adaptations being most popular. Three studies directly compared these 2 popular adaptations and demonstrated substantial agreement (κ > 0.70) and similar predictive ability for mortality. Third, one study validated the Charlson index for critically ill patients but demonstrated that APACHE (Acute Physiology and Chronic Health Evaluation) II better discriminates inhospital mortality (area under curve 0.67 vs 0.87). Time and cost barriers prevent widespread use of physiology-based risk adjustment in population-based research. The decreased predictive ability of the Charlson index must be weighed against the advantages of using this instrument for population-based research. Future research should focus on updating the Charlson index for recent changes in the prognosis of comorbid diseases and introduction of International Statistical Classification of Diseases, 10th Revision coding of discharge abstracts.

Original languageEnglish (US)
Pages (from-to)12-19
Number of pages8
JournalJournal of Critical Care
Volume20
Issue number1
DOIs
StatePublished - Mar 2005

Fingerprint

Risk Adjustment
Critical Care
Comorbidity
Databases
Research
Manitoba
APACHE
Mortality
Health Services Research
International Classification of Diseases
Hospital Mortality
Critical Illness
Population
Area Under Curve
Costs and Cost Analysis

Keywords

  • Comorbidity
  • Critical care
  • Health services research
  • Risk adjustment
  • Severity of illness index

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

A systematic review of the Charlson comorbidity index using Canadian administrative databases : A perspective on risk adjustment in critical care research. / Needham, Dale; Scales, Damon C.; Laupacis, Andreas; Pronovost, Peter J.

In: Journal of Critical Care, Vol. 20, No. 1, 03.2005, p. 12-19.

Research output: Contribution to journalArticle

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