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How accurate is the reporting of stroke in hospital discharge data? A pilot validation study using a population-based stroke registry as control

机译：在出院数据中报告中风的准确性如何？使用基于人群的中风注册表作为对照的试点验证研究

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Population-based stroke registries can provide valid stroke incidence because they ensure exhaustiveness of case ascertainment. However, their results are difficult to extrapolate because they cover a small population. The French Hospital Discharge Database (FHDDB), which routinely collects administrative data, could be a useful tool for providing data on the nationwide burden of stroke. The aim of our pilot study was to assess the validity of stroke diagnosis reported in the FHDDB. All records of patients with a diagnosis of stroke between 2004 and 2008 were retrieved from the FHDDB of Dijon Teaching Hospital. The Dijon Stroke Registry was considered as the gold standard. The sensitivity, positive predictive value (PPV), and weighted kappa were calculated. The Dijon Stroke Registry identified 811 patients with a stroke, among whom 186 were missed by the FHDDB and thus considered false-negatives. The FHDDB identified 903 patients discharged following a stroke including 625 true-positives confirmed by the registry and 278 false-positives. The overall sensitivity and PPV of the FHDDB for the diagnosis of stroke were, respectively, 77.1 % (95 % CI 74.2–80) and 69.2 % (95 % CI 66.1–72.2). For cardioembolic and lacunar strokes, the FHDDB yielded higher PPVs (respectively 86.7 and 84.6 %; p < 0.0001) than those of other stroke subtypes. The PPV but not sensitivity significantly increased over the years (p < 0.0001). Agreement with the stroke registry was moderate (kappa 52.8; 95 % CI 46.8–58.9). The FHDDB-based stroke diagnosis showed moderate validity compared with the Dijon Stroke Registry as the gold standard. However, its accuracy (PPV) increased with time and was higher for some stroke subtypes.
机译：基于人口的中风注册可以确保有效的中风确定性，因此可以提供有效的中风发生率。但是，由于其覆盖的人口很少，因此难以推断其结果。法国医院出院数据库（FHDDB）通常会收集管理数据，它可能是提供有关全国性中风负担数据的有用工具。我们的初步研究的目的是评估FHDDB中报告的中风诊断的有效性。从第戎教学医院的FHDDB中检索出2004年至2008年之间所有诊断为中风的患者的记录。第戎中风注册表被认为是黄金标准。计算灵敏度，阳性预测值（PPV）和加权κ。第戎中风注册中心确定了811名中风患者，其中FHDDB漏诊了186名患者，因此被认为是假阴性。 FHDDB确定了903名中风后出院的患者，其中包括经登记处确认的625例阳性和278例假阳性。 FHDDB对中风诊断的整体敏感性和PPV分别为77.1％（95％CI 74.2–80）和69.2％（95％CI 66.1-72.2）。对于心脏栓塞性和腔隙性中风，FHDDB产生的PPV高于其他中风亚型（分别为86.7％和84.6％; p <0.0001）。这些年来，PPV而不是敏感性显着增加（p <0.0001）。与卒中登记处的同意程度中等（kappa 52.8; 95％CI 46.8-58.9）。与第戎中风注册系统作为金标准相比，基于FHDDB的中风诊断显示出中等的有效性。但是，其准确性（PPV）随时间增加，对于某些中风亚型则更高。

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