Intracerebral hemorrhage: positive predictive value of diagnosis codes in two nationwide Danish registries

Hald, Stine Munk; Sloth, Christine Kring; Hey, Sabine Morris; Madsen, Claus B.; Nguyen, Nina; Rodrı́guez, Luis A. Garcı́a; Salman, Rustam Al-Shahi; Möller, Sören; Poulsen, Frantz Rom; Pottegård, Anton; Garcı́a-Dorado, David

doi:10.2147/clep.s167576

Cited by 28 publications

(53 citation statements)

References 23 publications

(26 reference statements)

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“…Four studies have reported data on the validity of ICH diagnoses in DNPR ( Supplementary Table S1). [32][33][34]36 Studies predating year 2000 reported PPVs of 66% 33 and 74%, 34 respectively, while a study 36 concerning data from 1993 to 2009 reported a PPV of 76%. Finally, a study 32 by our group with data from the same region as the present study for the years 2010-2015 reported a PPV of 75% for s-ICH in DNPR.…”

Section: Discussionmentioning

confidence: 99%

“…Patients suspected of a stroke are principally admitted or transferred to one of the four dedicated stroke units at neurology departments in the region, which also hosts a single neurosurgery department. 32 All hospitals in Denmark report data in a standardized format to the DNPR. 39 The Danish Stroke Registry (DSR), a clinical database, was established in Denmark in 2003 to monitor the quality of care provided to stroke patients.…”

Section: Setting and Data Sourcesmentioning

confidence: 99%

“…40,41 The regional authorities have copies of all hospital electronic medical records (EMRs) in RSD, which can be used for research purposes, provided consent is obtained from the heads of departments involved in patient care. 32 We identified all hospital contacts of residents of RSD recorded in DNPR (data since 2007 made available to us) or DSR (data since 2003, when the register became operational). In DNPR, for the period January 1, 2007 to December 31, 2017 we retrieved information on any hospital contacts (ie, inpatient, outpatient, or emergency department contacts) with International Classification of Diseases version 10 (ICD-10) I61 (intracerebral hemorrhage) as the principal diagnostic code (in Danish, "aktionsdiagnose") or in any other diagnostic position.…”

Section: Setting and Data Sourcesmentioning

confidence: 99%

“…30,31 In Denmark, two nationwide registers are of particular use for identifying patients with stroke for research purposes: the Danish Stroke Registry (DSR) and the Danish National Patient Registry (DNPR). The sensitivity of ICH diagnoses in these registers is unknown, and to date only a few studies have examined the validity of ICH diagnoses in DSR 32 or DNPR. [33][34][35][36] Supplementary Table S1 summarizes the existing studies.…”

Section: Introductionmentioning

confidence: 99%

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<p>The Validity of Intracerebral Hemorrhage Diagnoses in the Danish Patient Registry and the Danish Stroke Registry</p>

Hald¹,

Sloth²,

Agger³

et al. 2020

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Purpose: To establish the validity of intracerebral hemorrhage (ICH) diagnoses in the Danish Stroke Registry (DSR) and the Danish National Patient Registry (DNPR). Patients and Methods: Based on discharge summaries and brain imaging reports, we estimated the positive predictive value (PPV) of a first-ever diagnosis code for ICH (ICD-10, code I61) for all patients in the Region of Southern Denmark (1.2 million) during 2009-2017 according to either DNPR or DSR. We estimated PPVs for any non-traumatic ICH (a-ICH) and spontaneous ICH (s-ICH) alone (ie, without underlying structural cause). We also calculated the sensitivity of these diagnoses in each of the registers. Finally, we classified the location of verified s-ICH. Results: A total of 3,956 patients with ICH diagnosis codes were studied (DSR only: 87; DNPR only: 1,513; both registries: 2,356). In the DSR, the PPVs were 86.5% (95% CI=85.1-87.8) for a-ICH and 81.8% (95% CI=80.2-83.3) for s-ICH. The PPVs in DNPR (discharge code, primary diagnostic position) were 76.2% (95% CI=74.7-77.6) for a-ICH and 70.2% (95% CI=68.6-71.8) for s-ICH. Sensitivity for a-ICH and s-ICH was 76.4% (95% CI=74.8-78.0) and 78.7% (95% CI=77.1-80.2) in DSR, and 87.3% (95% CI=86.0-88.5) and 87.7% (95% CI=86.3-88.9) in DNPR. The location of verified s-ICH was lobar (39%), deep (33.6%), infratentorial (13.2%), large unclassifiable (11%), isolated intraventricular (1.9%), or unclassifiable due to insufficient information (1.3%). Conclusion: The validity of a-ICH diagnoses is high in both registries. For s-ICH, PPV was higher in DSR, while sensitivity was higher in DNPR. The location of s-ICH was similar to distributions seen in other populations.

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Section: Discussionmentioning

confidence: 99%

Section: Setting and Data Sourcesmentioning

confidence: 99%

Section: Setting and Data Sourcesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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<p>The Validity of Intracerebral Hemorrhage Diagnoses in the Danish Patient Registry and the Danish Stroke Registry</p>

Hald¹,

Sloth²,

Agger³

et al. 2020

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“…This allowed us to control for prevalence bias. The positive predictive values of hematological cancer diagnoses, cardiovascular diagnoses, and bleeding diagnoses in the DCR and DNPR are high . Several limitations also should be addressed.…”

Section: Discussionmentioning

confidence: 99%

Risk of thromboembolic and bleeding outcomes following hematological cancers: A Danish population‐based cohort study

Adelborg

Corraini

Darvalics

et al. 2019

Journal of Thrombosis and Haemostasis

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Background: Therapeutic advances have improved survival after hematological cancers. In turn, patients may be at increased risk of thromboembolic and bleeding events.Objectives: To examine the risks of myocardial infarction (MI), ischemic stroke, venous thromboembolism (VTE), and bleeding requiring hospital contact in patients with hematological cancers. Methods:We conducted a Danish population-based cohort study (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013). We identified all adult hematological cancer patients and sampled a general population comparison cohort in a 1:5 ratio matched by age, sex, previous thromboembolic events, bleeding, and solid cancer. Ten-year absolute risks of thromboembolism and bleeding were calculated and hazard ratios (HRs) were computed, controlling for matching factors.Results: Among 32 141 hematological cancer patients, the 10-year absolute risk of any thromboembolic or bleeding complication following hematological cancer was 19%: 3.3% for MI, 3.5% for ischemic stroke, 5.2% for VTE, and 8.5% for bleeding.Except among patients with myeloid leukemia, acute lymphoid leukemia, or myelodysplastic syndrome, the risk of thromboembolic events surpassed that of bleeding.The hematological cancer cohort overall was at increased risk for MI [HR = 1.36, 95% confidence interval (CI): 1.25-1.49], ischemic stroke (HR = 1.22, 95% CI: 1.12-1.33), VTE (HR = 3.37, 95% CI: 3.13-3.64), and bleeding (HR = 2.39, 95% CI: 2.26-2.53) compared with the general population. Conclusions:Approximately 2 of 10 hematological cancer patients experienced MI, ischemic stroke, VTE, or bleeding requiring hospital contact within 10 years. The hematological cancer cohort had higher hazards of MI, ischemic stroke, VTE, and bleeding requiring hospital contact than a general population comparison cohort. K E Y W O R D Scohort study, epidemiology, hematological cancer, myocardial infarction, stroke, venous thromboembolism 2.50 (0.Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Adelborg K, Corraini P, Darvalics B, et al. Risk of thromboembolic and bleeding outcomes following hematological cancers: A Danish population-based cohort study. J Thromb Haemost. 2019;17:1305-1318. https ://doi.

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Major Cardiovascular Events After Spontaneous Intracerebral Hemorrhage by Hematoma Location

et al. 2023

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ImportanceSurvivors of spontaneous (ie, nontraumatic and with no known structural cause) intracerebral hemorrhage (ICH) have an increased risk of major cardiovascular events (MACEs), including recurrent ICH, ischemic stroke (IS), and myocardial infarction (MI). Only limited data are available from large, unselected population studies assessing the risk of MACEs according to index hematoma location.ObjectiveTo examine the risk of MACEs (ie, the composite of ICH, IS, spontaneous intracranial extra-axial hemorrhage, MI, systemic embolism, or vascular death) after ICH based on ICH location (lobar vs nonlobar).Design, Setting, and ParticipantsThis cohort study identified 2819 patients in southern Denmark (population of 1.2 million) 50 years or older hospitalized with first-ever spontaneous ICH from January 1, 2009, to December 31, 2018. Intracerebral hemorrhage was categorized as lobar or nonlobar, and the cohorts were linked to registry data until the end of 2018 to identify the occurrence of MACEs and separately recurrent ICH, IS, and MI. Outcome events were validated using medical records. Associations were adjusted for potential confounders using inverse probability weighting.ExposureLocation of ICH (lobar vs nonlobar).Main Outcomes and MeasuresThe main outcomes were MACEs and separately recurrent ICH, IS, and MI. Crude absolute event rates per 100 person-years and adjusted hazard ratios (aHRs) with 95% CIs were calculated. Data were analyzed from February to September 2022.ResultsCompared with patients with nonlobar ICH (n = 1255; 680 [54.2%] men and 575 [45.8%] women; mean [SD] age, 73.5 [11.4] years), those with lobar ICH (n = 1034; 495 [47.9%] men and 539 [52.1%] women, mean [SD] age, 75.2 [10.7] years) had higher rates of MACEs per 100 person-years (10.84 [95% CI, 9.51-12.37] vs 7.91 [95% CI, 6.93-9.03]; aHR, 1.26; 95% CI, 1.10-1.44) and recurrent ICH (3.74 [95% CI, 3.01-4.66] vs 1.24 [95% CI, 0.89-1.73]; aHR, 2.63; 95% CI, 1.97-3.49) but not IS (1.45 [95% CI, 1.02-2.06] vs 1.77 [95% CI, 1.34-2.34]; aHR, 0.81; 95% CI, 0.60-1.10) or MI (0.42 [95% CI, 0.22-0.81] vs 0.64 [95% CI, 0.40-1.01]; aHR, 0.64; 95% CI, 0.38-1.09).Conclusions and RelevanceIn this cohort study, spontaneous lobar ICH was associated with a higher rate of subsequent MACEs than nonlobar ICH, primarily due to a higher rate of recurrent ICH. This study highlights the importance of secondary ICH prevention strategies in patients with lobar ICH.

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Intracerebral hemorrhage: positive predictive value of diagnosis codes in two nationwide Danish registries

Cited by 28 publications

References 23 publications

<p>The Validity of Intracerebral Hemorrhage Diagnoses in the Danish Patient Registry and the Danish Stroke Registry</p>

<p>The Validity of Intracerebral Hemorrhage Diagnoses in the Danish Patient Registry and the Danish Stroke Registry</p>

Risk of thromboembolic and bleeding outcomes following hematological cancers: A Danish population‐based cohort study

Major Cardiovascular Events After Spontaneous Intracerebral Hemorrhage by Hematoma Location

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