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Open Access 01-12-2023 | Forearm Fracture | Original Article

Validation of forearm fracture diagnoses in administrative patient registers

Authors: Tone Kristin Omsland, Lene B. Solberg, Åshild Bjørnerem, Tove T. Borgen, Camilla Andreasen, Torbjørn Wisløff, Gunhild Hagen, Trude Basso, Jan-Erik Gjertsen, Ellen M. Apalset, Wender Figved, Jens M. Stutzer, Frida I. Nissen, Ann K. Hansen, Ragnar M. Joakimsen, Elisa Figari, Geoffrey Peel, Ali A. Rashid, Jashar Khoshkhabari, Erik F. Eriksen, Lars Nordsletten, Frede Frihagen, Cecilie Dahl

Published in: Archives of Osteoporosis | Issue 1/2023

Abstract

Summary

The validity of forearm fracture diagnoses recorded in five Norwegian hospitals was investigated using image reports and medical records as gold standard. A relatively high completeness and correctness of the diagnoses was found. Algorithms used to define forearm fractures in administrative data should depend on study purpose.

Purpose

In Norway, forearm fractures are routinely recorded in the Norwegian Patient Registry (NPR). However, these data have not been validated. Data from patient administrative systems (PAS) at hospitals are sent unabridged to NPR. By using data from PAS, we aimed to examine (1) the validity of the forearm fracture diagnoses and (2) the usefulness of washout periods, follow-up codes, and procedure codes to define incident forearm fracture cases.

Methods

This hospital-based validation study included women and men aged ≥ 19 years referred to five hospitals for treatment of a forearm fracture during selected periods in 2015. Administrative data for the ICD-10 forearm fracture code S52 (with all subgroups) in PAS and the medical records were reviewed. X-ray and computed tomography (CT) reports from examinations of forearms were reviewed independently and linked to the data from PAS. Sensitivity and positive predictive values (PPVs) were calculated using image reports and/or review of medical records as gold standard.

Results

Among the 8482 reviewed image reports and medical records, 624 patients were identified with an incident forearm fracture during the study period. The sensitivity of PAS registrations was 90.4% (95% CI: 87.8–92.6). The PPV increased from 73.9% (95% CI: 70.6–77.0) in crude data to 90.5% (95% CI: 88.0–92.7) when using a washout period of 6 months. Using procedure codes and follow-up codes in addition to 6-months washout increased the PPV to 94.0%, but the sensitivity fell to 69.0%.

Conclusion

A relatively high sensitivity of forearm fracture diagnoses was found in PAS. PPV varied depending on the algorithms used to define cases. Choice of algorithm should therefore depend on study purposes. The results give useful measures of forearm fracture diagnoses from administrative patient registers. Depending on local coding practices and treatment pathways, we infer that the findings are relevant to other fracture diagnoses and registers.

Thygesen LC, Ersboll AK (2014) When the entire population is the sample: strengths and limitations in register-based epidemiology. Eur J Epidemiol 29:551–558. https://doi.org/10.1007/s10654-013-9873-0CrossRefPubMed

Schmidt M, Schmidt SA, Sandegaard JL, Ehrenstein V, Pedersen L, Sorensen HT (2015) The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 7:449–490. https://doi.org/10.2147/CLEP.S91125CrossRefPubMedPubMedCentral

Arts DG, De Keizer NF, Scheffer GJ (2002) Defining and improving data quality in medical registries: a literature review, case study, and generic framework. J Am Med Inform Assoc 9:600–611. https://doi.org/10.1197/jamia.m1087CrossRefPubMedPubMedCentral

Ehrenstein V, Petersen I, Smeeth L, Jick SS, Benchimol EI, Ludvigsson JF, Sorensen HT (2016) Helping everyone do better: a call for validation studies of routinely recorded health data. Clin Epidemiol 8:49–51. https://doi.org/10.2147/CLEP.S104448CrossRefPubMedPubMedCentral

Lofthus CM, Frihagen F, Meyer HE, Nordsletten L, Melhuus K, Falch JA (2008) Epidemiology of distal forearm fractures in Oslo. Norway Osteoporos Int 19:781–786. https://doi.org/10.1007/s00198-007-0499-5CrossRefPubMed

Kvernmo HD, Otterdal P, Balteskard L (2017) Treatment of wrist fractures 2009–14. Tidsskr Nor Laegeforen 137. https://doi.org/10.4045/tidsskr.17.0065

Omsland TK, Holvik K, Meyer HE, Center JR, Emaus N, Tell GS, Schei B, Tverdal A, Gjesdal CG, Grimnes G, Forsmo S, Eisman JA, Sogaard AJ (2012) Hip fractures in Norway 1999–2008: time trends in total incidence and second hip fracture rates: a NOREPOS study. Eur J Epidemiol 27:807–814. https://doi.org/10.1007/s10654-012-9711-9CrossRefPubMed

Sogaard AJ, Holvik K, Meyer HE, Tell GS, Gjesdal CG, Emaus N, Grimnes G, Schei B, Forsmo S, Omsland TK (2016) Continued decline in hip fracture incidence in Norway: a NOREPOS study. Osteoporos Int 27:2217–2222. https://doi.org/10.1007/s00198-016-3516-8CrossRefPubMed

Hoiberg MP, Gram J, Hermann P, Brixen K, Haugeberg G (2014) The incidence of hip fractures in Norway -accuracy of the national Norwegian patient registry. BMC Musculoskelet Disord 15:372. https://doi.org/10.1186/1471-2474-15-372CrossRefPubMedPubMedCentral

10.

Dahl C, Ohm E, Solbakken SM, Anwar N, Holvik K, Madsen C, Frihagen F, Bjornerem A, Igland Nissen F, Solberg LB, Omsland TK (2023) Forearm fractures - are we counting them all? An attempt to identify and include the missing fractures treated in primary care. Scand J Prim Health Care 1–10. https://doi.org/10.1080/02813432.2023.2231028

11.

Andreasen C, Solberg LB, Basso T, Borgen TT, Dahl C, Wisloff T, Hagen G, Apalset EM, Gjertsen JE, Figved W, Hubschle LM, Stutzer JM, Elvenes J, Joakimsen RM, Syversen U, Eriksen EF, Nordsletten L, Frihagen F, Omsland TK, Bjornerem A (2018) Effect of a fracture liaison service on the rate of subsequent fracture among patients with a fragility fracture in the Norwegian Capture the Fracture Initiative (NoFRACT): a trial protocol. JAMA Netw Open 1:e185701. https://doi.org/10.1001/jamanetworkopen.2018.5701CrossRefPubMedPubMedCentral

12.

Brophy S, John G, Evans E, Lyons RA (2006) Methodological issues in the identification of hip fractures using routine hospital data: a database study. Osteoporos Int 17:405–409. https://doi.org/10.1007/s00198-005-2038-6CrossRefPubMed

13.

Langley J, Stephenson S, Cryer C, Borman B (2002) Traps for the unwary in estimating person based injury incidence using hospital discharge data. Inj Prev 8:332–337. https://doi.org/10.1136/ip.8.4.332CrossRefPubMedPubMedCentral

14.

Boufous S, Williamson A (2003) Reporting of the incidence of hospitalised injuries: numerator issues. Inj Prev 9:370–375. https://doi.org/10.1136/ip.9.4.370CrossRefPubMedPubMedCentral

15.

Laugesen K, Ludvigsson JF, Schmidt M, Gissler M, Valdimarsdottir UA, Lunde A, Sorensen HT (2021) Nordic health registry-based research: a review of health care systems and key registries. Clin Epidemiol 13:533–554. https://doi.org/10.2147/CLEP.S314959CrossRefPubMedPubMedCentral

16.

Varmdal T, Bakken IJ, Janszky I, Wethal T, Ellekjaer H, Rohweder G, Fjaertoft H, Ebbing M, Bonaa KH (2016) Comparison of the validity of stroke diagnoses in a medical quality register and an administrative health register. Scand J Public Health 44:143–149. https://doi.org/10.1177/1403494815621641CrossRefPubMed

17.

Rosengren BE, Karlsson M, Petersson I, Englund M (2015) The 21st-century landscape of adult fractures: cohort study of a complete adult regional population. J Bone Miner Res 30:535–542. https://doi.org/10.1002/jbmr.2370CrossRefPubMed

18.

Karimi D, Houkjaer L, Gundtoft P, Brorson S, Viberg B (2023) Positive predictive value of humeral fractures in the Danish National Patient Registry. Dan Med J 70(4):A10220612PubMed

19.

Lass P, Lilholt J, Thomsen L, Lundbye-Christensen S, Enevoldsen H, Simonsen OH (2006) The quality of diagnosis and procedure coding in Orthopaedic surgery Northern Jutland. Ugeskr Laeger 168:4212–4215PubMed

20.

Sund R, Nurmi-Luthje I, Luthje P, Tanninen S, Narinen A, Keskimaki I (2007) Comparing properties of audit data and routinely collected register data in case of performance assessment of hip fracture treatment in Finland. Methods Inf Med 46:558–566. https://doi.org/10.1160/me0382CrossRefPubMed

21.

Fox MP, Lash TL, Bodnar LM (2020) Common misconceptions about validation studies. Int J Epidemiol 49:1392–1396. https://doi.org/10.1093/ije/dyaa090CrossRefPubMedPubMedCentral

22.

Kanis JA, Johansson H, Oden A, Harvey NC, Gudnason V, Sanders KM, Sigurdsson G, Siggeirsdottir K, Fitzpatrick LA, Borgstrom F, McCloskey EV (2018) Characteristics of recurrent fractures. Osteoporos Int 29:1747–1757. https://doi.org/10.1007/s00198-018-4502-0CrossRefPubMedPubMedCentral

Title: Validation of forearm fracture diagnoses in administrative patient registers
Authors: Tone Kristin Omsland
Lene B. Solberg
Åshild Bjørnerem
Tove T. Borgen
Camilla Andreasen
Torbjørn Wisløff
Gunhild Hagen
Trude Basso
Jan-Erik Gjertsen
Ellen M. Apalset
Wender Figved
Jens M. Stutzer
Frida I. Nissen
Ann K. Hansen
Ragnar M. Joakimsen
Elisa Figari
Geoffrey Peel
Ali A. Rashid
Jashar Khoshkhabari
Erik F. Eriksen
Lars Nordsletten
Frede Frihagen
Cecilie Dahl
Publication date: 01-12-2023
Publisher: Springer London
Keyword: Forearm Fracture
Published in: Archives of Osteoporosis / Issue 1/2023
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-023-01322-x

At a glance: The STEP trials

Springer Medicine

Validation of forearm fracture diagnoses in administrative patient registers

Abstract

Summary

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

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