The Positive Predictive Value of Pediatric Stroke Diagnoses in Administrative Data: A Retrospective Validation Study
Research output: Contribution to journal › Journal article › Research › peer-review
Standard
The Positive Predictive Value of Pediatric Stroke Diagnoses in Administrative Data : A Retrospective Validation Study. / Bindslev, Julie Brix; Johnsen, Soeren Paaske; Hansen, Klaus; Valentin, Jan Brink; Hoei-Hansen, Christina Engel; Truelsen, Thomas.
In: Clinical Epidemiology, Vol. 15, 2023, p. 755-764.Research output: Contribution to journal › Journal article › Research › peer-review
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - The Positive Predictive Value of Pediatric Stroke Diagnoses in Administrative Data
T2 - A Retrospective Validation Study
AU - Bindslev, Julie Brix
AU - Johnsen, Soeren Paaske
AU - Hansen, Klaus
AU - Valentin, Jan Brink
AU - Hoei-Hansen, Christina Engel
AU - Truelsen, Thomas
N1 - Publisher Copyright: © 2023 Bindslev et al.
PY - 2023
Y1 - 2023
N2 - Background: This retrospective cohort study aimed to examine the positive predictive value (PPV) of pediatric stroke diagnoses in the Danish National Registry of Patients (DNRP) and the impact of different stroke definitions on the PPV. Methods: We included children registered with a stroke or stroke-related diagnosis in the DNRP between January 2017 through December 2020. Two assessors reviewed medical records and validated cases according to the American Heart and American Stroke Association (AHA/ASA) stroke definition. The level of interrater agreement was examined using kappa statistics. Validation by the AHA/ASA definition was compared with validation according to the definition in the International Classification of Disease 11th version (ICD-11) and the World Health Organization’s definition. Results: Stroke was confirmed in 120 of 309 included children, yielding an overall PPV of 0.39 (95% CI: 0.33–0.45). PPV varied across stroke subtypes from 0.83 (95% CI: 0.71–0.92) for ischemic stroke (AIS), 0.57 (95% CI: 0.37–0.76) for unspecified stroke, 0.42 (95% CI: 0.33–0.52) for intracerebral hemorrhage (ICH) to 0.31 (95% CI: 0.55–0.98) and 0.07 (95% CI: 0.01–0.22) for cerebral venous thrombosis and subarachnoid hemorrhage (SAH), respectively. Most non-confirmed ICH and SAH diagnoses were in children with traumatic intracranial hemorrhages (36 and 66% respectively). Among 70 confirmed AIS cases, 25 (36%) were identified in non-AIS code groups. PPV varied significantly across stroke definitions with the highest for the AHA/ASA definition (PPV = 0.39, 95% CI: 0.34–0.45) and the lowest for the WHO definition (PPV = 0.29, 95% CI: 0.24–0.34). Correspondingly, the incidence of pediatric AIS per 100.000 person-years changed from 1.5 for the AHA/ASA definition to 1.2 for ICD-11 and 1.0 for the WHO-definition. The overall interrater agreement was considered excellent (κ=0.85). Conclusion: After validation, stroke was confirmed in only half of the children registered in the DNRP with a stroke-specific diagnosis. Non-validated administrative data should be used with caution in pediatric stroke research. Pediatric stroke incidence rates may vary markedly depending on which stroke definition is used.
AB - Background: This retrospective cohort study aimed to examine the positive predictive value (PPV) of pediatric stroke diagnoses in the Danish National Registry of Patients (DNRP) and the impact of different stroke definitions on the PPV. Methods: We included children registered with a stroke or stroke-related diagnosis in the DNRP between January 2017 through December 2020. Two assessors reviewed medical records and validated cases according to the American Heart and American Stroke Association (AHA/ASA) stroke definition. The level of interrater agreement was examined using kappa statistics. Validation by the AHA/ASA definition was compared with validation according to the definition in the International Classification of Disease 11th version (ICD-11) and the World Health Organization’s definition. Results: Stroke was confirmed in 120 of 309 included children, yielding an overall PPV of 0.39 (95% CI: 0.33–0.45). PPV varied across stroke subtypes from 0.83 (95% CI: 0.71–0.92) for ischemic stroke (AIS), 0.57 (95% CI: 0.37–0.76) for unspecified stroke, 0.42 (95% CI: 0.33–0.52) for intracerebral hemorrhage (ICH) to 0.31 (95% CI: 0.55–0.98) and 0.07 (95% CI: 0.01–0.22) for cerebral venous thrombosis and subarachnoid hemorrhage (SAH), respectively. Most non-confirmed ICH and SAH diagnoses were in children with traumatic intracranial hemorrhages (36 and 66% respectively). Among 70 confirmed AIS cases, 25 (36%) were identified in non-AIS code groups. PPV varied significantly across stroke definitions with the highest for the AHA/ASA definition (PPV = 0.39, 95% CI: 0.34–0.45) and the lowest for the WHO definition (PPV = 0.29, 95% CI: 0.24–0.34). Correspondingly, the incidence of pediatric AIS per 100.000 person-years changed from 1.5 for the AHA/ASA definition to 1.2 for ICD-11 and 1.0 for the WHO-definition. The overall interrater agreement was considered excellent (κ=0.85). Conclusion: After validation, stroke was confirmed in only half of the children registered in the DNRP with a stroke-specific diagnosis. Non-validated administrative data should be used with caution in pediatric stroke research. Pediatric stroke incidence rates may vary markedly depending on which stroke definition is used.
KW - children
KW - Danish National Registry of Patients
KW - interrater reliability
KW - positive predictive value
KW - stroke definition
KW - stroke diagnosis
U2 - 10.2147/CLEP.S414913
DO - 10.2147/CLEP.S414913
M3 - Journal article
C2 - 37360512
AN - SCOPUS:85163695764
VL - 15
SP - 755
EP - 764
JO - Clinical Epidemiology
JF - Clinical Epidemiology
SN - 1179-1349
ER -
ID: 363063092