Hall Ruth, Mondor Luke, Porter Joan, Fang Jiming, Kapral Moira K
1Institute for Clinical Evaluative Sciences,Toronto,Ontario,Canada.
Can J Neurol Sci. 2016 Nov;43(6):765-773. doi: 10.1017/cjn.2016.278. Epub 2016 Jul 18.
Administrative data validation is essential for identifying biases and misclassification in research. The objective of this study was to determine the accuracy of diagnostic codes for acute stroke and transient ischemic attack (TIA) using the Ontario Stroke Registry (OSR) as the reference standard.
We identified stroke and TIA events in inpatient and emergency department (ED) administrative data from eight regional stroke centres in Ontario, Canada, from April of 2006 through March of 2008 using ICD-10-CA codes for subarachnoid haemorrhage (I60, excluding I60.8), intracerebral haemorrhage (I61), ischemic (H34.1 and I63, excluding I63.6), unable to determine stroke (I64), and TIA (H34.0 and G45, excluding G45.4). We linked administrative data to the Ontario Stroke Registry and calculated sensitivity and positive predictive value (PPV).
We identified 5,270 inpatient and 4,411 ED events from the administrative data. Inpatient administrative data had an overall sensitivity of 82.2% (95% confidence interval [CI 95%]=81.0, 83.3) and a PPV of 68.8% (CI 95%=67.5, 70.0) for the diagnosis of stroke, with notable differences observed by stroke type. Sensitivity for ischemic stroke increased from 66.5 to 79.6% with inclusion of I64. The sensitivity and PPV of ED administrative data for diagnosis of stroke were 56.8% (CI 95%=54.8, 58.7) and 59.1% (CI 95%=57.1, 61.1), respectively. For all stroke types, accuracy was greater in the inpatient data than in the ED data.
The accuracy of stroke identification based on administrative data from stroke centres may be improved by including I64 in ischemic stroke type, and by considering only inpatient data.
行政数据验证对于识别研究中的偏差和错误分类至关重要。本研究的目的是使用安大略省卒中登记处（OSR）作为参考标准，确定急性卒中和短暂性脑缺血发作（TIA）诊断代码的准确性。
我们使用国际疾病分类第十版加拿大修订本（ICD - 10 - CA）代码，识别了2006年4月至2008年3月期间加拿大安大略省八个地区卒中中心的住院患者和急诊科（ED）行政数据中的卒中和TIA事件，这些代码用于蛛网膜下腔出血（I60，不包括I60.8）、脑出血（I61）、缺血性（H34.1和I63，不包括I63.6）、无法确定的卒中（I64）以及TIA（H34.0和G45，不包括G45.4）。我们将行政数据与安大略省卒中登记处相链接，并计算敏感性和阳性预测值（PPV）。
我们从行政数据中识别出5270例住院患者事件和4411例急诊科事件。住院患者行政数据对卒中诊断的总体敏感性为82.2%（95%置信区间[CI 95%]=81.0, 83.3），PPV为68.8%（CI 95%=67.5, 70.0），不同卒中类型存在显著差异。将I64纳入缺血性卒中后，其敏感性从66.5%提高到79.6%。急诊科行政数据对卒中诊断的敏感性和PPV分别为56.8%（CI 95%=54.8, 58.7）和59.1%（CI 95%=57.1, 61.1）。对于所有卒中类型，住院患者数据的准确性高于急诊科数据。
将I64纳入缺血性卒中类型，并仅考虑住院患者数据，可能会提高基于卒中中心行政数据的卒中识别准确性。
