Departments of Obstetrics and Gynecology (Ross, Fast, Slade) and Family Medicine (Miyagishima, Soos, Taylor, Drummond), University of Alberta; Women & Children's Health Research Institute (Ross), Edmonton, Alta.; Departments of Family Medicine (Garies, Jackson, Doraty, Drummond) and Community Health Sciences (Williamson), University of Calgary, Calgary, Alta.
CMAJ Open. 2020 May 28;8(2):E414-E419. doi: 10.9778/cmajo.20190145. Print 2020 Apr-Jun.
To date, there has been no validated method to identify cases of pelvic floor disorders in primary care electronic medical record (EMR) data. We aimed to develop and validate symptom-based case definitions for urinary incontinence, fecal incontinence and pelvic organ prolapse in women, for use in primary care epidemiologic or clinical research.
Our retrospective study used EMR data from the Southern Alberta Primary Care Research Network (SAPCReN) and the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) in southern Alberta. Trained researchers remotely reviewed a random sample of EMR charts of women aged 18 years or older from 6 rural and urban clinics to validate case definitions for urinary incontinence, fecal incontinence and pelvic organ prolapse. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and estimated SAPCReN prevalence as appropriate.
Charts of 900 women were included. Sensitivity was 81.9% (95% confidence interval [CI] 75.1-87.2) for urinary incontinence, 61.2% (95% CI 46.2-74.5) for fecal incontinence, and 51.8% (95% CI 40.6-62.8) for pelvic organ prolapse. Corresponding specificity values were 71.9% (95% CI 68.4-75.1), 99.2% (95% CI 98.2-99.6) and 98.8% (95% CI 97.7-99.4), PPVs 40.6% (95% CI 35.4-46.0), 81.1% (95% CI 64.3-91.4) and 81.1% (95% CI 67.6-90.1), and NPVs 94.4% (95% CI 92.1-96.1), 97.8% (95% CI 96.5-98.6) and 95.3% (95% CI 93.6-96.6). The SAPCReN-observed prevalence for urinary incontinence was 29.7% (95% CI 29.3-30.0), but the adjusted prevalence was 2.97%.
The case definition for urinary incontinence met our standard for validity (sensitivity and specificity > 70%), and the case definitions for fecal incontinence and pelvic organ prolapse had PPVs greater than 80%. The urinary incontinence definition may be used in epidemiologic research, and those for fecal incontinence and pelvic organ prolapse may be used in quality-improvement studies or creation of disease registries. Our symptom-based case definitions could also be adapted for research in other EMR settings.
迄今为止，尚无经证实的方法可用于在初级保健电子病历 (EMR) 数据中识别盆底疾病病例。我们旨在为女性制定并验证基于症状的尿失禁、粪失禁和盆腔器官脱垂的病例定义，以便在初级保健流行病学或临床研究中使用。
我们的回顾性研究使用了来自南阿尔伯塔初级保健研究网络 (SAPCReN) 和加拿大初级保健监测网络 (CPCSSN) 的 EMR 数据，这些数据来自阿尔伯塔省南部的 6 家农村和城市诊所。经过培训的研究人员远程审查了来自 18 岁及以上女性的随机 EMR 图表样本，以验证尿失禁、粪失禁和盆腔器官脱垂的病例定义。我们计算了敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV)，并适当估计了 SAPCReN 的患病率。
共纳入 900 名女性的图表。尿失禁的敏感性为 81.9%（95%置信区间 [CI] 75.1-87.2），粪失禁为 61.2%（95% CI 46.2-74.5），盆腔器官脱垂为 51.8%（95% CI 40.6-62.8）。相应的特异性值分别为 71.9%（95% CI 68.4-75.1）、99.2%（95% CI 98.2-99.6）和 98.8%（95% CI 97.7-99.4），PPV 分别为 40.6%（95% CI 35.4-46.0）、81.1%（95% CI 64.3-91.4）和 81.1%（95% CI 67.6-90.1），NPV 分别为 94.4%（95% CI 92.1-96.1）、97.8%（95% CI 96.5-98.6）和 95.3%（95% CI 93.6-96.6）。SAPCReN 观察到的尿失禁患病率为 29.7%（95% CI 29.3-30.0），但调整后的患病率为 2.97%。
尿失禁的病例定义符合我们的有效性标准（敏感性和特异性>70%），而粪失禁和盆腔器官脱垂的病例定义的阳性预测值大于 80%。尿失禁的定义可用于流行病学研究，而粪失禁和盆腔器官脱垂的定义可用于质量改进研究或疾病登记处的创建。我们的基于症状的病例定义也可适用于其他 EMR 环境的研究。
