Baghestan Elham, Børdahl Per E, Rasmussen Svein A, Sande Anne K, Lyslo Ingvill, Solvang Isabel
Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway.
Acta Obstet Gynecol Scand. 2007;86(2):205-9. doi: 10.1080/00016340601111364.
The purpose of the present study was to validate the registration of obstetric sphincter tears in 2 registers, the Medical Birth Registry of Norway [MBRN] and Patient Administration System [PAS].
A retrospective cohort study of all obstetric sphincter tears that occurred in our department in 1990-1992 and 2000-2002 was performed. The case records of all patients registered either in MBRN, PAS or the birth logs were compared with the information in the medical records, which constituted the 'golden standard'.
The incidence of obstetric sphincter tears in 1990-1992 was 5.8% (774/13381), 5.6% (745/13381) had a perineal tear of third degree and 0.2% (29/13381) of fourth degree. In 2000-2002, the total incidence was 6.6% (813/12380), 5.9% (731/12380) was a third degree perineal tear and 0.7% (82/12380) fourth degree, respectively. The sensitivity and specificity of the MBRN database to detect obstetric sphincter tears was 85.3 and 99.5% in 1990-1992, and 91.8 and 99.7% in 2000-2002, respectively. The positive and negative predictive values of a MBRN-registered diagnosis of obstetric sphincter tears in 1990-1992 were 91.4 and 99.1%, while the corresponding percentages in 2000-2002 were 95.4 and 99.4%, respectively. The sensitivity and specificity of the PAS database was correspondingly 52.1 and 99.0% in 1990-1992, and 84.6 and 98.5% in 2000-2002. The positive and negative predictive values of a PAS-diagnosis of obstetric sphincter tears were 75.8 and 97.1% in 1990-1992. In 2000-2002, they were 92.7 and 98.9%, respectively.
The validity of a diagnosis of obstetric sphincter tears, based on the MBRN, is sufficiently high to justify future large-scale epidemiologic studies based on this database, while the validity of a PAS diagnosis is lower, but improves.
本研究的目的是验证挪威医疗出生登记处[MBRN]和患者管理系统[PAS]中产科括约肌撕裂的登记情况。
对1990 - 1992年及2000 - 2002年在我们科室发生的所有产科括约肌撕裂进行回顾性队列研究。将在MBRN、PAS或出生登记或出生记录中的所有患者的病历与构成“金标准”的病历信息进行比较。
1990 - 1992年产科括约肌撕裂的发生率为5.8%（774/13381），5.6%（745/13381）为三度会阴撕裂，0.2%（29/13381）为四度撕裂。2000 - 2002年，总发生率分别为6.6%（813/12380），5.9%（731/12380）为三度会阴撕裂，0.7%（82/12380）为四度撕裂。1990 - 1992年MBRN数据库检测产科括约肌撕裂的敏感性和特异性分别为85.3%和99.5%，2000 - 2002年分别为91.8%和99.7%。1990 - 1992年MBRN登记诊断产科括约肌撕裂的阳性和阴性预测值分别为91.4%和99.1%，而2000 - 2002年相应百分比分别为95.4%和99.4%。1990 - 1992年PAS数据库的敏感性和特异性分别为52.1%和99.0%，2000 - 2002年分别为84.6%和98.5%。1990 - 1992年PAS诊断产科括约肌撕裂的阳性和阴性预测值分别为75.8%和97.1%。2000 - 2002年，分别为92.7%和98.9%。
基于MBRN的产科括约肌撕裂诊断的有效性足够高，足以证明未来基于该数据库进行大规模流行病学研究的合理性，而PAS诊断的有效性较低，但有所提高。
