Schwartz Sara S, Pedersen Mette Gb, Frøslev Trine, Madsen Nicolas, Olsen Morten S
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus, Denmark.
Medical /Steno Aarhus Research Laboratories, Aarhus University Hospital, Palle Juul Jensens Blvd 165, Aarhus, Denmark.
Int J Cardiol Congenit Heart Dis. 2022 Apr 11;8:100372. doi: 10.1016/j.ijcchd.2022.100372. eCollection 2022 Jun.
Congenital heart disease (CHD) is a public health concern as the most common birth defect with growing prevalence in adults. Valid CHD data are critical in clinical epidemiological CHD research.
To evaluate the positive predictive value (PPV) of having a CHD diagnosis and related surgery registered in the population-based Danish National Patient Registry (DNPR) according to the International Classification of Diseases, 8th and 10th revision, using predefined exclusion criteria to increase diagnostic validity.
Using medical record review as reference standard, we computed the PPV of registered diagnostic codes for CHD and CHD subtypes including 95% confidence intervals (CIs) as well as the PPV of presence of CHD-related surgery. A sample of 480 patients diagnosed with CHD at any hospital in the Central Jutland region, during 1977-2013, was randomly selected for the medical record review. Reviews were performed by two paediatric cardiology nurses, blinded to the specific CHD diagnosis, and a paediatric cardiologist was consulted in cases of uncertainty.
We located medical records of 463 of the 480 patients included (96%), and found an overall PPV of the CHD diagnosis of 95.5 (95%CI: 93.3-97.1). Subtype specific PPVs were generally lower. In example PPV for atrial septal defect was 69%. It increased to 78% after inclusion of persistent foramen ovale in the reference standard subtype definition. The overall PPV of CHD-related surgery codes was 92.7.
The overall PPV of CHD diagnoses in the DNPR is high. Data indicated lower PPVs for CHD subtypes.
先天性心脏病（CHD）作为最常见的出生缺陷，在成年人中的患病率不断上升，是一个公共卫生问题。有效的CHD数据在临床流行病学CHD研究中至关重要。
根据国际疾病分类第8版和第10版，使用预定义的排除标准来提高诊断有效性，评估在基于人群的丹麦国家患者登记处（DNPR）中登记的CHD诊断和相关手术的阳性预测值（PPV）。
以病历审查作为参考标准，我们计算了CHD及CHD亚型登记诊断代码的PPV，包括95%置信区间（CI）以及CHD相关手术存在情况的PPV。随机选取了1977 - 2013年期间在日德兰半岛中部地区任何医院被诊断为CHD的480例患者进行病历审查。由两名对特定CHD诊断不知情的儿科心脏病护士进行审查，在存在不确定性的情况下咨询儿科心脏病专家。
我们找到了纳入的480例患者中463例（96%）的病历，发现CHD诊断的总体PPV为95.5（95%CI：93.3 - 97.1）。亚型特异性PPV一般较低。例如，房间隔缺损的PPV为69%。在参考标准亚型定义中纳入持续性卵圆孔未闭后，该值增至78%。CHD相关手术代码的总体PPV为92.7。
DNPR中CHD诊断的总体PPV较高。数据表明CHD亚型的PPV较低。
