van de Vorst I E, Vaartjes I, Sinnecker L F, Beks L J M, Bots M L, Koek H L
Julius Center for Health Sciences and Primary Care, Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands.
Neth J Med. 2015 Feb;73(2):69-75.
Most information on the incidence and prognosis of dementia comes from small studies with limited precision and generalisability. Nationwide registers can be an alternative source of information, but only when the diagnosis is validly recorded. We assessed the validity of the Dutch Hospital Discharge Register (HDR).
HDR data on dementia diagnoses (ICD-9 codes 290.0; 290.1; 290.3; 290.4; 294.1; 331.0; 331.1; 331.82) in a university medical centre in the Netherlands were collected. Diagnoses were verified by using hospital medical records. Positive predictive values (PPVs) were calculated. Multivariate logistic regression models were used to evaluate determinants of inaccuracy in discharge diagnoses.
A sample of the HDR data was used for this study (n = 340). PPV was 93.2% for overall dementia, indicating confirmation of 93.2% of HDR dementia diagnoses by the medical records. The accuracy of the diagnosis of overall dementia in patients aged ≥ 65 years was significantly higher compared with younger patients (PPV 95.5 % vs. 67.9%; p = 0.0001). There was no difference in the accuracy of the diagnosis between men and women and accuracy was not influenced by type of admission, comorbidity and polypharmacy.
The results of this study show a high validity of the diagnosis of overall dementia in the HDR, making this register of great value for further nationwide research on dementia.
大多数关于痴呆症发病率和预后的信息来自精确度和普遍性有限的小型研究。全国性登记册可以作为另一种信息来源，但前提是诊断记录有效。我们评估了荷兰医院出院登记册（HDR）的有效性。
收集了荷兰一家大学医学中心HDR中关于痴呆症诊断（国际疾病分类第九版代码290.0；290.1；290.3；290.4；294.1；331.0；331.1；331.82）的数据。通过使用医院病历对诊断进行核实。计算阳性预测值（PPV）。使用多变量逻辑回归模型评估出院诊断不准确的决定因素。
本研究使用了HDR数据样本（n = 340）。总体痴呆症的PPV为93.2%，这表明病历证实了HDR中93.2%的痴呆症诊断。≥65岁患者总体痴呆症诊断的准确性明显高于年轻患者（PPV 95.5%对67.9%；p = 0.0001）。男性和女性之间的诊断准确性没有差异，准确性也不受入院类型、合并症和多种药物治疗的影响。
本研究结果表明HDR中总体痴呆症诊断具有较高的有效性，这使得该登记册对于进一步开展全国性痴呆症研究具有重要价值。
