The Positive Predictive Value of Pediatric Stroke Diagnoses in Administrative Data: A Retrospective Validation Study.

IF 3.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology Pub Date : 2023-01-01 DOI:10.2147/CLEP.S414913

Julie Brix Bindslev, Soeren Paaske Johnsen, Klaus Hansen, Jan Brink Valentin, Christina Engel Hoei-Hansen, Thomas Truelsen

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引用次数: 1

Abstract

Background: This retrospective cohort study aimed to examine the positive predictive value (PPV) of pediatric stroke diagnoses in the Danish National Registry of Patients (DNRP) and the impact of different stroke definitions on the PPV.

Methods: We included children registered with a stroke or stroke-related diagnosis in the DNRP between January 2017 through December 2020. Two assessors reviewed medical records and validated cases according to the American Heart and American Stroke Association (AHA/ASA) stroke definition. The level of interrater agreement was examined using kappa statistics. Validation by the AHA/ASA definition was compared with validation according to the definition in the International Classification of Disease 11th version (ICD-11) and the World Health Organization's definition.

Results: Stroke was confirmed in 120 of 309 included children, yielding an overall PPV of 0.39 (95% CI: 0.33-0.45). PPV varied across stroke subtypes from 0.83 (95% CI: 0.71-0.92) for ischemic stroke (AIS), 0.57 (95% CI: 0.37-0.76) for unspecified stroke, 0.42 (95% CI: 0.33-0.52) for intracerebral hemorrhage (ICH) to 0.31 (95% CI: 0.55-0.98) and 0.07 (95% CI: 0.01-0.22) for cerebral venous thrombosis and subarachnoid hemorrhage (SAH), respectively. Most non-confirmed ICH and SAH diagnoses were in children with traumatic intracranial hemorrhages (36 and 66% respectively). Among 70 confirmed AIS cases, 25 (36%) were identified in non-AIS code groups. PPV varied significantly across stroke definitions with the highest for the AHA/ASA definition (PPV = 0.39, 95% CI: 0.34-0.45) and the lowest for the WHO definition (PPV = 0.29, 95% CI: 0.24-0.34). Correspondingly, the incidence of pediatric AIS per 100.000 person-years changed from 1.5 for the AHA/ASA definition to 1.2 for ICD-11 and 1.0 for the WHO-definition. The overall interrater agreement was considered excellent (κ=0.85).

Conclusion: After validation, stroke was confirmed in only half of the children registered in the DNRP with a stroke-specific diagnosis. Non-validated administrative data should be used with caution in pediatric stroke research. Pediatric stroke incidence rates may vary markedly depending on which stroke definition is used.

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行政资料中儿童脑卒中诊断的积极预测价值:一项回顾性验证研究。

背景:本回顾性队列研究旨在研究丹麦国家患者登记册(DNRP)中儿童卒中诊断的阳性预测值(PPV)以及不同卒中定义对PPV的影响。方法:我们纳入了2017年1月至2020年12月期间在DNRP中登记为卒中或卒中相关诊断的儿童。两名评估人员根据美国心脏和美国中风协会(AHA/ASA)中风定义审查了医疗记录并验证了病例。使用kappa统计来检验翻译人员的一致性水平。将AHA/ASA定义的有效性与国际疾病分类第11版(ICD-11)和世界卫生组织定义的有效性进行比较。结果:309名纳入的儿童中有120名卒中确诊，总PPV为0.39 (95% CI: 0.33-0.45)。不同脑卒中亚型的PPV分别为:缺血性脑卒中(AIS)的0.83 (95% CI: 0.71-0.92)、未指定脑卒中的0.57 (95% CI: 0.37-0.76)、脑出血(ICH)的0.42 (95% CI: 0.33-0.52)、脑静脉血栓形成和蛛网膜下腔出血(SAH)的0.31 (95% CI: 0.55-0.98)和0.07 (95% CI: 0.01-0.22)。大多数未确诊的脑出血和SAH诊断发生在外伤性颅内出血的儿童中(分别为36%和66%)。在70例AIS确诊病例中，25例(36%)在非AIS编码组中被发现。不同中风定义的PPV差异显著，AHA/ASA定义的PPV最高(PPV = 0.39, 95% CI: 0.34-0.45)， WHO定义的PPV最低(PPV = 0.29, 95% CI: 0.24-0.34)。相应地，儿童AIS的发生率从AHA/ASA定义的每10万人年1.5例变为ICD-11的1.2例和who定义的1.0例。总体判读一致性极佳(κ=0.85)。结论:经过验证，在DNRP中登记的具有卒中特异性诊断的儿童中，只有一半被确诊为卒中。在小儿卒中研究中应谨慎使用未经验证的行政数据。小儿中风的发病率可能会因中风定义的不同而有显著差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.

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