Wermuth Lene, Cui Xin, Greene Naomi, Schernhammer Eva, Ritz Beate
Department of Neurology, Odense University Hospital, Odense, Denmark.
Department of Epidemiology, University of California, Los Angeles, School of Public Health, Los Angeles, CA, USA.
Parkinsons Dis. 2015;2015:781479. doi: 10.1155/2015/781479. Epub 2015 Dec 3.
Background. The electronic medical records provide new and unprecedented opportunities for large population-based and clinical studies if valid and reliable diagnoses can be obtained, to determine what information is needed to distinguish idiopathic PD from Parkinsonism in electronic medical records. Methods. Chart review of complete medical records of 2,446 patients with a hospital discharge diagnosis of PD, who, between 1996 and 2009, were registered in the Danish National Hospital Register as idiopathic PD. All patients were examined in neurology departments. Clinical features were abstracted from charts to determine Parkinsonian phenotypes and disease course, using predefined criteria for idiopathic PD. Results. Chart review verified that 2,068 (84.5%) patients met criteria for idiopathic PD. The most distinguishing features of idiopathic PD patients were asymmetric onset, and fewer atypical features at onset or follow-up compared to Parkinsonism, and the area under the curve (AUC) for these items alone is moderate (0.74-0.77) and the highest AUC (0.91) was achieved when using all clinical features recorded in addition to PD medication use and a follow-up of 5 years or more. Conclusion. To reduce disease misclassification, information extracted from medical record review with at least 5 years of follow-up after first diagnosis was key to improve diagnostic accuracy.
背景。如果能够获得有效且可靠的诊断结果，电子病历可为大规模基于人群的研究和临床研究提供全新且前所未有的机遇，以确定在电子病历中区分特发性帕金森病（PD）与帕金森综合征所需的信息。方法。对2446例出院诊断为PD的患者的完整病历进行图表审查，这些患者在1996年至2009年间被登记在丹麦国家医院登记册中，诊断为特发性PD。所有患者均在神经科接受检查。使用特发性PD的预定义标准，从图表中提取临床特征，以确定帕金森病表型和病程。结果。图表审查证实，2068例（84.5%）患者符合特发性PD的标准。特发性PD患者最具区别性的特征是起病不对称，与帕金森综合征相比，起病时或随访期间的非典型特征较少，仅这些项目的曲线下面积（AUC）为中等（0.74 - 0.77），当使用除PD药物使用情况以及5年或更长时间的随访外记录的所有临床特征时，AUC最高（0.91）。结论。为减少疾病误诊，首次诊断后至少5年的病历审查所提取的信息是提高诊断准确性的关键。
