Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Manitoba Centre for Health Policy, University of Manitoba, Winnipeg MB, Canada.
Mult Scler Relat Disord. 2018 Oct;25:258-264. doi: 10.1016/j.msard.2018.08.013. Epub 2018 Aug 13.
We aimed to validate administrative case definitions to identify individuals with optic neuritis (ON) or transverse myelitis (TM), and to distinguish which of these individuals had a monophasic presentation versus multiple sclerosis (MS).
Using population-based administrative (health claims) data from Manitoba, Canada, we developed case definitions for ON and TM, and distinguished individuals who had monophasic presentations (ON-nonMS, TM-nonMS) versus those later diagnosed with MS (ON-MS, TM-MS). We compared performance of these case definitions to diagnoses based on medical records review in a reference cohort (n = 1251) using sensitivity, specificity, positive predictive value and negative predictive value. We estimated the annual incidence of these conditions for a three-year period (2011-2013).
When compared to medical records, using ≥1 physician visit, the case definition for ON had good sensitivity (88.5%), and specificity (82.7%) whereas the case definition for TM had low sensitivity (25.9%) and higher specificity (89.0%). Findings for the other case definitions tested were: ON-MS (sensitivity: 84.1%, specificity: 83.9%), ON-nonMS (sensitivity: 66.7%, specificity 98.5%), TM-MS (sensitivity: 22.2%, specificity: 90.4%), and TM-nonMS (sensitivity: 3.7%, specificity: 99.7%). After applying the ON and TM case definitions to administrative data, the average annual incidence of ON over the period 2011-2013 was 75.9 per 100,000 person-years (95%CI: 72.8, 79.1) and of TM was 18.3 per 100,000 person-years (95%CI: 16.8, 19.8).
Administrative data can be used to identify individuals with incident ON and TM, and to distinguish those with monophasic syndromes from those with an incident presentation of MS.
我们旨在验证行政病例定义，以确定视神经炎（ON）或横贯性脊髓炎（TM）患者，并区分这些患者中单相表现与多发性硬化症（MS）患者。
利用来自加拿大马尼托巴省的基于人群的行政（健康索赔）数据，我们制定了 ON 和 TM 的病例定义，并区分了具有单相表现的个体（ON-nonMS、TM-nonMS）与随后被诊断为 MS 的个体（ON-MS、TM-MS）。我们在参考队列（n=1251）中使用敏感性、特异性、阳性预测值和阴性预测值比较了这些病例定义与基于病历回顾的诊断结果。我们估计了这两种疾病在三年期间（2011-2013 年）的年度发病率。
与病历相比，使用≥1 次就诊，ON 的病例定义具有良好的敏感性（88.5%）和特异性（82.7%），而 TM 的病例定义敏感性较低（25.9%），特异性较高（89.0%）。其他测试的病例定义的结果为：ON-MS（敏感性：84.1%，特异性：83.9%）、ON-nonMS（敏感性：66.7%，特异性 98.5%）、TM-MS（敏感性：22.2%，特异性：90.4%）和 TM-nonMS（敏感性：3.7%，特异性：99.7%）。在将 ON 和 TM 病例定义应用于行政数据后，2011-2013 年期间 ON 的平均年发病率为 75.9/100,000 人年（95%CI：72.8, 79.1），TM 为 18.3/100,000 人年（95%CI：16.8, 19.8）。
行政数据可用于识别新发 ON 和 TM 患者，并区分单相综合征患者与新发 MS 患者。
