Stroke, Vol 25, 2348-2355, Copyright © 1994 by American Heart Association
CL Leibson, JM Naessens, RD Brown and JP Whisnant
BACKGROUND AND PURPOSE: Much of the available data on stroke occurrence,
service use, and cost of care originated with hospital discharge abstracts.
This article uses the unique resources of the Rochester Epidemiology
Project to estimate the sensitivity and positive predictive value of
hospital discharge abstracts for incident stroke. METHODS: The Rochester
Stroke Registry was used to identify all confirmed first strokes
(hospitalized and nonhospitalized) among Rochester residents for 1970,
1980, 1984, and 1989 (n = 364). The sensitivity of discharge abstracts was
estimated by following these individuals for 12 months after stroke to
determine the proportion assigned a discharge diagnosis of cerebrovascular
disease (International Classification of Diseases [ICD] codes 430 through
438.9). The positive predictive value of discharge abstracts was assessed
by identifying all hospitalizations of Rochester residents with an ICD code
of 430-438.9 in 1970, 1980, and 1989 (n = 377). Events were categorized as
incident stroke, recurrent stroke, stroke sequelae, or nonstroke after
review of the complete community-based medical record by a neurologist.
RESULTS: Only 86% (n = 313) of all first- stroke patients in 1970, 1980,
1984, and 1989 were hospitalized. Of hospitalized patients, only 76% were
assigned a principal discharge diagnosis code of 430-438.9. Fatal strokes
and those occurring during a hospitalization were less likely to be
identified. Among all hospitalizations of Rochester residents in 1970,
1980, and 1989, there were 377 with a principal diagnosis code of
430-438.9. Less than half (n = 177) were determined by the neurologist to
be incident stroke; only 60% (n = 225) were either incident or recurrent
stroke. Comparison of alternative approaches showed the validity of
discharge abstracts was enhanced by increasing the number of diagnoses and
excluding codes with poor positive predictive value. CONCLUSIONS: This
study provides previously unavailable estimates of the sensitivity of
stroke-coded hospitalizations for a US community. A model for improving the
sensitivity and positive predictive value of discharge abstracts is
presented.
ARTICLES
Accuracy of hospital discharge abstracts for identifying stroke
Department of Health Sciences Research, Mayo Clinic, Rochester, Minn. 55905.
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