Johnsen Søren P, Overvad Kim, Sørensen Henrik Toft, Tjønneland Anne, Husted Steen E
Department of Epidemiology and Social Medicine, Aarhus University, Vennelyst Boulevard 6, Aarhus C, Denmark.
J Clin Epidemiol. 2002 Jun;55(6):602-7. doi: 10.1016/s0895-4356(02)00391-8.
We examined the predictive value of the discharge diagnoses of stroke and transient ischemic attack (TIA) in The National Registry of Patients (NRP) for participants in the Danish cohort study "Diet, Cancer, and Health." We retrieved all probable incident registered cases of stroke and TIA, i.e., ICD-10: I60-69.8, or G45 (n = 581) within the cohort from the NRP. Medical records and hospital discharge summaries were retrieved and reviewed using a standardized form. Overall, 299 of 377 cases (79.3%, 95% CI: 74.9-83.3%) of stroke recorded were confirmed. Subarachnoidal hemorrhage and intracerebral hemorrhage were confirmed in 14 of 29 cases (48.3%, 95% CI: 29.4-67.5%), and 23 of 35 cases (65.7%, 95% CI: 47.8-80.9%), respectively. By contrast, ischemic stroke and unspecified stroke were confirmed in 99 of 113 cases (87.6%, 95% CI: 80.1-93.1%) and 152 of 200 cases (76.0%, 95% CI: 69.5-81.7%), respectively. Among 134 patients with a TIA discharge diagnosis, 60.4% (95% CI: 51.6-68.8%) were confirmed. Discharge diagnoses from emergency rooms had lower overall predictive value (48.8%, 95% CI: 39.9-57.8%) than discharge diagnoses from departments of internal medicine (68.8%, 95% CI: 61.3-75.5%) and departments of neurology or neurosurgery (77.9%, 95% CI: 72.3-82.7%). We conclude that stroke and TIA diagnoses in NRP should be used with caution in epidemiological research because the low predictive value for some diagnostic subgroups may lead to serious misclassification and biased results.
我们在丹麦队列研究“饮食、癌症与健康”中，检验了国家患者登记处（NRP）中中风和短暂性脑缺血发作（TIA）出院诊断对参与者的预测价值。我们从NRP中检索了该队列中所有可能的中风和TIA的登记发病病例，即国际疾病分类第十版（ICD - 10）编码为I60 - 69.8或G45的病例（n = 581）。使用标准化表格检索并审查了病历和医院出院小结。总体而言，记录的377例中风病例中有299例（79.3%，95%置信区间：74.9 - 83.3%）得到确诊。蛛网膜下腔出血和脑出血分别在29例中的14例（48.3%，95%置信区间：29.4 - 67.5%）和35例中的23例（65.7%，95%置信区间：47.8 - 80.9%）中得到确诊。相比之下，缺血性中风和未明确类型的中风分别在113例中的99例（87.6%，95%置信区间：80.1 - 93.1%）和200例中的152例（76.0%，95%置信区间：69.5 - 81.7%）中得到确诊。在134例出院诊断为TIA的患者中，60.4%（95%置信区间：51.6 - 68.8%）得到确诊。急诊室的出院诊断总体预测价值（48.8%，95%置信区间：39.9 - 57.8%）低于内科（68.8%，95%置信区间：61.3 - 75.5%）以及神经内科或神经外科（77.9%，95%置信区间：72.3 - 82.7%）的出院诊断。我们得出结论，在流行病学研究中应谨慎使用NRP中的中风和TIA诊断，因为某些诊断亚组的预测价值较低可能导致严重的错误分类和有偏差的结果。
