To Teresa, Dell Sharon, Dick Paul T, Cicutto Lisa, Harris Jennifer K, MacLusky Ian B, Tassoudji Marjan
Population Health Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
Pediatr Allergy Immunol. 2006 Feb;17(1):69-76. doi: 10.1111/j.1399-3038.2005.00346.x.
Asthma is an important chronic childhood illness. A population-based surveillance program could measure the burden of illness, but first, the validity of an administrative diagnosis of asthma must be confirmed. The objective was to evaluate the accuracy of population-based outpatient administrative data in identifying children with asthma for the purpose of on-going asthma surveillance and research. Twenty-one primary care physician (PCP) clinics in Ontario participated. Patients under 18 yr old were categorized into three diagnosis categories according to administrative data diagnosis codes: asthma, asthma-related, and non-asthma. In each PCP clinic, for each diagnosis category, 10 charts were randomly selected for abstraction. A panel of experts (blind to the code) reviewed the abstracted charts and identified them as asthma or non-asthma. The reviewers' diagnosis was considered the gold standard. The accuracy of the administrative data diagnosis coding was analyzed using the concepts of diagnostic test evaluation. Six hundred and thirty patient charts were abstracted and reviewed. Overall agreement between the diagnosis provided by expert chart review and the administrative data diagnosis code was 84.8% (p < 0.001), and was 60.2%, 94.8% and 99.5% for the asthma, asthma-related, and non-asthma categories, respectively. Additionally, the sensitivity and specificity were 91.4% and 82.9%, respectively. Agreement between the administrative data diagnosis code and the PCP chart diagnosis was 99.4% (p < 0.001). An administrative data diagnosis code of asthma is sensitive and specific for identifying asthma. By using the results of this study as a starting point, future research will create a cohort of children with asthma to be used for population-based surveillance and research.
哮喘是一种重要的儿童慢性疾病。基于人群的监测项目可以衡量疾病负担，但首先，必须确认哮喘行政诊断的有效性。目的是评估基于人群的门诊行政数据在识别哮喘儿童以进行持续哮喘监测和研究方面的准确性。安大略省的21家初级保健医生（PCP）诊所参与了研究。18岁以下的患者根据行政数据诊断代码被分为三类诊断类别：哮喘、哮喘相关和非哮喘。在每个PCP诊所，对于每个诊断类别，随机抽取10份病历进行摘要。一组专家（对代码不知情）审查了摘要病历，并将其确定为哮喘或非哮喘。审查者的诊断被视为金标准。使用诊断试验评估的概念分析行政数据诊断编码的准确性。共抽取并审查了630份患者病历。专家病历审查提供的诊断与行政数据诊断代码之间的总体一致性为84.8%（p<0.001），哮喘、哮喘相关和非哮喘类别的一致性分别为60.2%、94.8%和99.5%。此外，敏感性和特异性分别为91.4%和82.9%。行政数据诊断代码与PCP病历诊断之间的一致性为99.4%（p<0.001）。哮喘的行政数据诊断代码在识别哮喘方面具有敏感性和特异性。以本研究结果为起点，未来的研究将创建一个哮喘儿童队列，用于基于人群的监测和研究。
