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      Call for Papers: Sex and Gender in Neurodegenerative Diseases

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      About Neurodegenerative Diseases: 1.9 Impact Factor I 5.9 CiteScore I 0.648 Scimago Journal & Country Rank (SJR)

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      Validity of Stroke Diagnoses in a National Register of Patients

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          Abstract

          Background: Many registers containing routine medical information have been developed for research and surveillance purposes. In epidemiological research assessment of endpoints is often conducted via registers. In the present study we validated stroke and transient ischemic attack (TIA) diagnoses in the Danish National Register of Patients (DNRP). Methods: Subjects from a Danish cohort study, the Copenhagen City Heart Study (n = 19,698), were crosslinked with the DNRP. The following International Classification of Disease 10th revision codes were used to identify possible strokes and TIAs: I60–I69 and G45. Two independent raters reviewed all cases. Positive predictive values of stroke, TIA and stroke subtypes were estimated by dividing the confirmed cases by the total number of cases located in the DNRP. Interrater reliability was tested using ĸ statistics. Results: Of 236 possible cerebrovascular events, 1 in 6 stroke diagnoses did not meet study criteria. The majority of events in the DNRP were registered as unspecified stroke (I64), n = 105 (44%), of which two thirds were diagnosed as ischemic stroke events by the raters. Intracerebral hemorrhage and ischemic stroke had a positive predictive value from 74 to 97%, respectively. Conclusion: Our results show that the DNRP tends to overestimate the number of cerebrovascular events, while ischemic stroke is underestimated.

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          Large sample standard errors of kappa and weighted kappa.

          Joseph Fleiss, Jacob Cohen V, B. S. Everitt (1969)
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            Kappa coefficients in medical research.

            Art Noda, Vyjeyanthi Periyakoil, Helena Kraemer (2002)
            Kappa coefficients are measures of correlation between categorical variables often used as reliability or validity coefficients. We recapitulate development and definitions of the K (categories) by M (ratings) kappas (K x M), discuss what they are well- or ill-designed to do, and summarize where kappas now stand with regard to their application in medical research. The 2 x M(M>/=2) intraclass kappa seems the ideal measure of binary reliability; a 2 x 2 weighted kappa is an excellent choice, though not a unique one, as a validity measure. For both the intraclass and weighted kappas, we address continuing problems with kappas. There are serious problems with using the K x M intraclass (K>2) or the various K x M weighted kappas for K>2 or M>2 in any context, either because they convey incomplete and possibly misleading information, or because other approaches are preferable to their use. We illustrate the use of the recommended kappas with applications in medical research. Copyright 2002 John Wiley & Sons, Ltd.
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              Predictive value of stroke and transient ischemic attack discharge diagnoses in The Danish National Registry of Patients.

              Søren P Johnsen, Kim Overvad, Henrik Toft Sørensen … (2002)
              We examined the predictive value of the discharge diagnoses of stroke and transient ischemic attack (TIA) in The National Registry of Patients (NRP) for participants in the Danish cohort study "Diet, Cancer, and Health." We retrieved all probable incident registered cases of stroke and TIA, i.e., ICD-10: I60-69.8, or G45 (n = 581) within the cohort from the NRP. Medical records and hospital discharge summaries were retrieved and reviewed using a standardized form. Overall, 299 of 377 cases (79.3%, 95% CI: 74.9-83.3%) of stroke recorded were confirmed. Subarachnoidal hemorrhage and intracerebral hemorrhage were confirmed in 14 of 29 cases (48.3%, 95% CI: 29.4-67.5%), and 23 of 35 cases (65.7%, 95% CI: 47.8-80.9%), respectively. By contrast, ischemic stroke and unspecified stroke were confirmed in 99 of 113 cases (87.6%, 95% CI: 80.1-93.1%) and 152 of 200 cases (76.0%, 95% CI: 69.5-81.7%), respectively. Among 134 patients with a TIA discharge diagnosis, 60.4% (95% CI: 51.6-68.8%) were confirmed. Discharge diagnoses from emergency rooms had lower overall predictive value (48.8%, 95% CI: 39.9-57.8%) than discharge diagnoses from departments of internal medicine (68.8%, 95% CI: 61.3-75.5%) and departments of neurology or neurosurgery (77.9%, 95% CI: 72.3-82.7%). We conclude that stroke and TIA diagnoses in NRP should be used with caution in epidemiological research because the low predictive value for some diagnostic subgroups may lead to serious misclassification and biased results.
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                Author and article information

                Journal
                Journal ID (publisher-id): NED
                Journal ID (nlm-ta): Neuroepidemiology
                Journal ID (doi): 10.1159/issn.0251-5350
                Title: Neuroepidemiology
                Publisher: S. Karger AG
                ISSN (Print): 0251-5350
                ISSN (Electronic): 1423-0208
                Publication date Subscription-year: 2007
                Publication date (Print): August 2007
                Publication date (Electronic): 03 May 2007
                Volume: 28
                Issue: 3
                Pages: 150-154
                Affiliations
                aDepartment of Neurology, Copenhagen University Hospital Bispebjerg, and bDanish Epidemiology Science Center at the Institute of Preventive Medicine of Copenhagen, Copenhagen, Denmark
                Article
                Publisher ID: 102143 Other ID: Neuroepidemiology 2007;28:150–154
                DOI: 10.1159/000102143
                PubMed ID: 17478969
                SO-VID: 98640542-7468-4160-852d-23b35bad9075
                Copyright © © 2007 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 25 September 2006
                Date accepted : 14 February 2007
                Page count
                Tables: 1, References: 21, Pages: 5
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
                Keywords: Danish National Register of Patients,Stroke diagnosis, validation,Interrater reliability,Epidemiology, stroke,Kappa statistics
                Data availability:
                ScienceOpen disciplines: Geriatric medicine, Neurology, Cardiovascular Medicine, Neurosciences, Clinical Psychology & Psychiatry, Public health
                Keywords: Danish National Register of Patients, Stroke diagnosis, validation, Interrater reliability, Epidemiology, stroke, Kappa statistics

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