Measuring Accuracy of Discharge Diagnoses for a Region-Wide Surveillance of Hospitalized Strokes

Abstract

Background and Purpose-Measuring the impact of stroke through population-based stroke registers is complex and costly. The aim of the present study is to assess the validity of hospital discharge diagnoses (all ages) and to estimate the total number of hospitalized stroke events in the Veneto region (Northeastern Italy, 4 500 000 inhabitants). Methods-All discharges covering a 1-year period (1999) sharply decreased in the other diagnostic levels. Code 342 also showed a high PPV. The probability of suspected events meeting the stroke definition increased with age and was highest for patients admitted to neurological wards and for fatal events. Overall 9400 strokes (first-ever and recurrent) were estimated to be hospitalized in 1999, with an attack rate of 208 per 100 000. Conclusions-Our data indicate that once validation studies are undertaken on a sample of all hospitalized events, hospital discharge records can provide a valuable source of information on the actual burden of strokes on hospital services.

Adherence to Antihypertensive Medications and Cardiovascular Morbidity Among Newly Diagnosed Hypertensive Patients

“…Several studies have in fact estimated a sensitivity ranging from 60% to 80% for AMI diagnosis 39 and the likelihood of ascertainment bias for stroke diagnosis because of the high case fatality rate. 40 The potential misclassification, however, is unlikely to be differential among the adherence groups.…”

Warfarin Use Associates with Increased Risk for Stroke in Hemodialysis Patients with Atrial Fibrillation

“…59,[61][62][63] Further details about the clinical data system with respect to the validation of data quality, the extraction of oral medication information, and its ability to facilitate the anonymous analysis of health care information are outlined in our previous publication. 12 …”

“…Study patients who achieved the primary outcome of stroke were older (P ϭ 0.008) with higher CHADS 2 scores (P ϭ 0.01), frequency of INR monitoring (P Ͻ 0.0001), systolic BP (P ϭ 0.04), warfarin use (P ϭ 0.0007), and prevalence of congestive heart failure (P ϭ 0.02) than patients who were censored, supporting the valid classification of patients with stroke in the clinical data system; furthermore, previous studies validate the diagnostic accuracy of stroke abstracted from medical records. 59,[61][62][63] Drug exposure status was determined by any use of warfarin (versus nonuse), clopidogrel (versus nonuse), or aspirin (versus nonuse) in the first 90 d of dialysis. Subsequent analysis confirms the accurate classification of warfarin prescription in the electronic medical records and patient compliance to the drug.…”

Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis

“…The use of ICD-9 codes to identify complications in large data sets is still being validated, and therefore limits the drawing of conclusions from the data. 36,39 In addition, patients in this study were not routinely screened for DVT with surveillance ultrasonography. A study in which neurosurgery patients underwent weekly venous duplex ultrasonography of the lower extremities reported a high rate (2.8%) of DVTs.…”