School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON Canada.
Department of Medicine and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON Canada, ICES.
Clin Invest Med. 2022 Sep 21;45(3):E9-13. doi: 10.25011/cim.v45i3.38874.
Epidemiological studies of primary subarachnoid hemorrhage (pSAH) frequently include population-based death registries for case finding. The positive predictive value of pSAH diagnoses in death registries is unknown.
This cross-sectional study identified all people in Ontario, Canada with pSAH listed as a cause of death between 2013 and 2017. pSAH was classified as "very likely" if diagnosis of pSAH was confirmed by autopsy, there was a previous hospitalization where pSAH probability exceeded 85% or death was preceded within a week by an emergency room visit where pSAH probability exceeded 25%. pSAH was classified as "very unlikely" if previous cerebrovascular imaging had never been done. Remaining cases were classified as "pSAH status unknown".
1,613 deaths attributed to pSAH were identified (mean 322/year). pSAH classification frequencies were as follows: very likely 528 (32.7%); very unlikely 433 (26.8%); and status unknown 652 (40.4%).
We found that a quarter of pSAH cases in our province's death registry were very unlikely to be true pSAH while 40% had unknown veracity. These data should be considered when using death registries for pSAH case finding.
原发性蛛网膜下腔出血（pSAH）的流行病学研究经常包括基于人群的死亡登记以发现病例。死亡登记中 pSAH 诊断的阳性预测值尚不清楚。
本横断面研究确定了 2013 年至 2017 年间在加拿大安大略省因 pSAH 列为死亡原因的所有人。如果 pSAH 的诊断通过尸检得到证实、先前有过 pSAH 概率超过 85%的住院记录或死亡前一周内急诊室就诊的 pSAH 概率超过 25%，则将 pSAH 分类为“很可能”。如果之前从未进行过脑血管成像，则将 pSAH 分类为“不太可能”。其余病例被归类为“pSAH 状态未知”。
确定了 1613 例归因于 pSAH 的死亡（平均每年 322 例）。pSAH 分类频率如下：很可能 528 例（32.7%）；不太可能 433 例（26.8%）；状态未知 652 例（40.4%）。
我们发现，我省死亡登记处的 pSAH 病例中有四分之一不太可能是真正的 pSAH，而 40%的病例真实性未知。在使用死亡登记寻找 pSAH 病例时，应考虑这些数据。
