Hjelholt Thomas J, Edwards Nina M, Vesterager Jeppe D, Kristensen Pia K, Pedersen Alma B
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
Department of Orthopedic Surgery, Horsens Regional Hospital, Horsens 8700, Denmark.
Clin Epidemiol. 2020 Feb 4;12:123-131. doi: 10.2147/CLEP.S238722. eCollection 2020.
The health-care databases may be a valuable source for epidemiological research in hip fracture surgery, if the diagnoses are valid. We examined the validity of hip fracture diagnoses and surgical procedure codes in the Danish Multidisciplinary Hip Fracture Registry (DMHFR) and the Danish National Patient Registry (DNPR) by calculating the positive predictive value (PPV).
We identified a random sample of 750 hip fracture patients registered in the DMHFR between 2014 and 2017. Diagnoses have been coded by the 10 revision of the International Classification of Diseases, while procedures have been coded by the Nordic Medico-Statistical Committee classification in the DNPR and directly transferred to the DMHFR. Using the surgical procedure description from the medical record as gold standard, we estimated the PPV of the hip fracture diagnoses and surgical procedure codes in the DMHFR and the DNPR with 95% confidence interval (CIs).
The PPV was 90% (95% CI: 86%-93%) for fracture of the neck of femur, 92% (95% CI: 87%-95%) for trochanteric fracture, and 83% (95% CI: 78%-88%) for subtrochanteric fracture. Joining trochanteric and subtrochanteric fracture resulted in a PPV of 97% (95% CI: 95%-98%). Procedure codes had a PPV of 100% for primary prosthetic replacement and internal fixation with intramedullary nail, 96% (95% CI: 85%-99%) for internal fixation using screws alone, 91% (95% CI: 84%-96%) for internal fixation using plates and screws, and 89% (95% CI: 83%-94%) for internal fixation with other or combined methods. Stratifying by age group, gender, hospital type and calendar year of surgery showed similar results as the overall PPV estimates.
Our findings indicate a high quality of the hip fracture diagnoses and corresponding procedure codes in the DMHFR and the DNPR, with a majority of PPVs above 90%. Thus, the DMHFR and the DNPR are a valuable data source on hip fracture for epidemiological research.
如果诊断有效，医疗保健数据库可能是髋部骨折手术流行病学研究的宝贵资源。我们通过计算阳性预测值（PPV）来检验丹麦多学科髋部骨折登记处（DMHFR）和丹麦国家患者登记处（DNPR）中髋部骨折诊断和手术程序编码的有效性。
我们从2014年至2017年在DMHFR登记的髋部骨折患者中随机抽取了750例样本。诊断按照《国际疾病分类》第10版进行编码，而手术程序在DNPR中按照北欧医学统计委员会分类进行编码，并直接传输到DMHFR。以病历中的手术程序描述作为金标准，我们估计了DMHFR和DNPR中髋部骨折诊断和手术程序编码的PPV及95%置信区间（CI）。
股骨颈骨折的PPV为90%（95%CI：86%-93%），转子间骨折为92%（95%CI：87%-95%），转子下骨折为83%（95%CI：78%-88%）。将转子间骨折和转子下骨折合并后，PPV为97%（95%CI：95%-98%）。手术程序编码中，初次假体置换和髓内钉内固定的PPV为100%，单纯使用螺钉内固定的PPV为96%（95%CI：85%-99%），使用钢板和螺钉内固定的PPV为91%（95%CI：84%-96%），使用其他或联合方法内固定的PPV为89%（95%CI：83%-94%）。按年龄组、性别、医院类型和手术年份分层显示的结果与总体PPV估计值相似。
我们的研究结果表明，DMHFR和DNPR中髋部骨折诊断及相应手术程序编码质量较高，大多数PPV高于90%。因此，DMHFR和DNPR是髋部骨折流行病学研究的宝贵数据源。
