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利用行政卫生数据验证加拿大非创伤性脊髓功能障碍患者识别算法

Validation of Algorithm to Identify Persons with Non-traumatic Spinal Cord Dysfunction in Canada Using Administrative Health Data.

作者信息

Ho Chester, Guilcher Sara J T, McKenzie Nicole, Mouneimne Magda, Williams Anita, Voth Jennifer, Chen Yan, Cronin Shawna, Noonan Vanessa K, Jaglal Susan B

机构信息

Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta.

Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta.

出版信息

Top Spinal Cord Inj Rehabil. 2017 Fall;23(4):333-342. doi: 10.1310/sci2304-333.

Abstract

Administrative health data, such as the hospital Discharge Abstract Database (DAD), can potentially be used to identify patients with non-traumatic spinal cord dysfunction (NTSCD). Algorithms utilizing administrative health data for this purpose should be validated before clinical use. To validate an algorithm designed to identify patients with NTSCD through DAD. DAD between 2006 and 2016 for Southern Alberta in Canada were obtained through Alberta Health Services. Cases of NTSCD were identified using the algorithm designed by the research team. These were then validated by chart review using electronic medical records where possible and paper records where electronic records were unavailable. Measures of diagnostic accuracy including sensitivity, specificity, and positive and negative predictive values and 95% confidence intervals (CI) were computed. Two hundred and eighty cases were identified to have both the administrative codes for neurological impairments and NTSCD etiology. Twenty-eight cases were excluded from analysis as 5 had inadequate medical record information, 17 had traumatic spinal cord injury, and 6 were considered "other" non-spinal cord conditions. Measures of diagnostic accuracy that were computed were sensitivity 97% (95% CI, 94%-98%), specificity 60% (95% CI, 47%-73%), positive predictive value (PPV) 92% (95% CI, 88%-95%), and negative predictive value (NPV) 80% (95% CI, 65%-90%). The most prevalent etiologies were degenerative (36.9%), infection (19.0%), oncology malignant (15.1%), and vascular (10.3%). Our algorithm has high sensitivity and PPV and satisfactory specificity and NPV for the identification of persons with NTSCD using DAD, though the limitations for using this method should be recognized.

摘要

行政健康数据,如医院出院摘要数据库(DAD),有可能用于识别非创伤性脊髓功能障碍(NTSCD)患者。为此目的利用行政健康数据的算法在临床使用前应进行验证。为了验证一种旨在通过DAD识别NTSCD患者的算法,通过艾伯塔省卫生服务部门获取了加拿大艾伯塔省南部2006年至2016年期间的DAD。使用研究团队设计的算法识别NTSCD病例。然后尽可能通过电子病历进行图表审查来验证这些病例,在没有电子记录的情况下则使用纸质记录。计算了包括敏感性、特异性、阳性和阴性预测值以及95%置信区间(CI)在内的诊断准确性指标。确定有280例同时具有神经损伤的行政代码和NTSCD病因。28例被排除在分析之外,因为5例病历信息不足,17例有创伤性脊髓损伤,6例被认为是“其他”非脊髓疾病。计算得到的诊断准确性指标为敏感性97%(95%CI,94%-98%),特异性60%(95%CI,47%-73%),阳性预测值(PPV)92%(95%CI,88%-95%),阴性预测值(NPV)80%(95%CI,65%-90%)。最常见的病因是退行性(36.9%)、感染(19.0%)、肿瘤恶性(15.1%)和血管性(10.3%)。我们的算法在使用DAD识别NTSCD患者方面具有较高的敏感性和PPV以及令人满意的特异性和NPV,不过应该认识到使用这种方法的局限性。

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本文引用的文献

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Top Spinal Cord Inj Rehabil. 2017 Fall;23(4):343-352. doi: 10.1310/sci2304-343.
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