Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul, Korea.
National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.
J Hand Surg Am. 2021 Nov;46(11):1026.e1-1026.e7. doi: 10.1016/j.jhsa.2021.03.001. Epub 2021 Apr 16.
To develop and validate identification criteria for distal radius fractures (DRFs) and their treatment using a national health insurance database.
Patients who had at least 1 wrist radiograph taken in 2018 were recruited from a single academic referral hospital. After excluding patients who lacked immobilization code for wrist pathology, we collected data on the overall population. Because some patients might have undergone wrist radiography at another institution or had DRFs without an immobilization code, we additionally included patients who had a DRF diagnosis code at our institution. Reviews of medical records and wrist radiographs were considered for the diagnosis of DRF. We evaluated the sensitivity, specificity, and positive predictive value (PPV) of 3 operational definitions of fractures that were based on a single primary or secondary diagnosis code; all diagnosis codes, including primary and secondary codes; and all diagnosis and procedure codes.
Among 768 patients included in the study, true DRFs were confirmed in 305. The sensitivity, specificity, and PPV for definition 1 were 91.5% (95% CI, 88.3%-94.6%), 97.5% (95% CI, 95.9%-99.1%), and 96.9% (95% CI, 94.9%-98.9%), respectively. Although the sensitivity of definition 2 was higher (92.1%; 95% CI, 89.1%-95.2%), its specificity and PPV were lower (96.4% [95% CI, 94.4%-98.3%] and 95.6% [95% CI, 93.2%-97.9%], respectively). The sensitivity of definition 3 was the lowest (88.2%; 95% CI, 84.6%-91.8%), but its specificity and PPV were the highest among the 3 definitions (98.6% [95% CI, 97.4%-98.8%] and 98.2% [95% CI, 96.6%-99.8%], respectively).
Patients with DRFs can be identified from claims databases with high accuracy using an operational definition based on DRF diagnosis and procedure codes, including codes for surgical and nonoperative methods.
Verified operational definitions will increase the consistency of results in future national health insurance database studies related to DRFs.
利用国家健康保险数据库开发和验证远端桡骨骨折（DRF）及其治疗的识别标准。
从一家学术转诊医院招募了至少有一次腕关节 X 光片的患者。排除未接受腕关节病理固定编码的患者后，我们收集了总体人群的数据。由于一些患者可能在其他机构进行了腕关节 X 光检查，或者存在未固定编码的 DRF，我们还纳入了在我们机构诊断为 DRF 的患者。对医疗记录和腕关节 X 光片进行审查以诊断 DRF。我们评估了基于单个主要或次要诊断代码的 3 种骨折操作定义的敏感性、特异性和阳性预测值（PPV）；所有诊断代码，包括主要和次要代码；以及所有诊断和手术代码。
在纳入的 768 名患者中，305 名患者被确认为真正的 DRF。定义 1 的敏感性、特异性和 PPV 分别为 91.5%（95%CI，88.3%-94.6%）、97.5%（95%CI，95.9%-99.1%）和 96.9%（95%CI，94.9%-98.9%）。尽管定义 2 的敏感性较高（92.1%；95%CI，89.1%-95.2%），但其特异性和 PPV 较低（96.4%[95%CI，94.4%-98.3%]和 95.6%[95%CI，93.2%-97.9%]）。定义 3 的敏感性最低（88.2%；95%CI，84.6%-91.8%），但在这 3 种定义中，其特异性和 PPV 最高（分别为 98.6%[95%CI，97.4%-98.8%]和 98.2%[95%CI，96.6%-99.8%]）。
使用基于 DRF 诊断和手术代码的操作定义（包括手术和非手术方法的代码），可以从索赔数据库中准确识别出 DRF 患者。
经过验证的操作定义将提高未来与 DRF 相关的国家健康保险数据库研究结果的一致性。
