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Completeness and Positive Predictive Value of Registration of Upper Limb Embolectomy in the Danish National Vascular Registry

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Completeness and Positive Predictive Value of Registration of Upper Limb Embolectomy in the Danish National Vascular Registry ORIGINAL RESEARCH Completeness and positive predictive value of registration of upper limb embolectomy in the Danish National Vascular Registry Ljubica V Andersen1 Objective: To evaluate completeness and positive predictive value of the Danish National Leif S Mortensen2 Vascular Registry regarding registration of the surgical procedures: embolectomy of brachial, Jes S Lindholt3 ulnar, or radial artery. Ole Faergeman4 Study design and settings: The study was based on fi rst-time embolectomies in the brachial, Eskild W Henneberg3 ulnar, or radial artery performed in Denmark from January 1, 1990 to December 31, 2002. The Lars Frost5 data were primarily retrieved from the Danish National Vascular Registry and secondarily from the Danish National Registry of Patients. Medical records were retrieved using a standardized form. 1 Department of Pharmacology, Results: In total, 1433 incident cases of fi rst-time embolectomy were found in both registries. Odense University Hospital, Denmark; 2UNI-C, The Danish IT The positive predictive value of the registration was 97.5% (95% confi dence interval [CI]; Centre for Education and Research, 96.4–98.4). 3 Aarhus, Denmark; Vascular The degree of completeness was 86.5% (95% CI; 84.3–88.5). For the registration period from Research Unit, Department of Vascular Surgery, Viborg Hospital, 1990 till 1996 the degree of completeness was 78.2% (95% CI; 74.4–81.7), and from 1997 till For personal use only. Denmark; 4Department of Cardiology 2002 it was 93.8% (95% CI; 91.6–95.7). and Internal Medicine, Aarhus The completeness and positive predictive value of registration of embolectomy University Hospital, Denmark; Conclusion: 5Department of Medicine, Silkeborg in the upper limb in the Danish National Vascular Registry was 86.5% and 97.5%, respectively. Hospital, Denmark This registry can be a valuable tool for epidemiological research and quality-monitoring. Keywords: positive predictive value, completeness, capture-recapture method, validity, embolectomy, registration. Introduction Embolectomy is an established surgical treatment of acute embolism in the upper limb. Clinical Epidemiology downloaded from https://www.dovepress.com/ by 54.70.40.11 on 14-Dec-2018 Embolism in the upper limb is a rare disease, and the true incidence is not known. The disease is mostly very painful, and it can necessitate brachial amputation. After embolism in an upper limb, reported rates of brachial amputation range from zero to 18% despite prompt surgical intervention.1 Use of data collected for quality control or for administrative reasons (secondary data) for research into rare diseases, such as upper limb embolism and its treatment, can be cost and time effective. It gives the opportunity to observe a large cohort over a long period of time. Many databases are not established for research purposes (primary data), but for quality control or for administrative purposes. The latter should, ideally, be planned according to rigorous standards, since it can be very cost and time effective to use 2 Correspondence: Ljubica V Andersen secondary data in research. If quality of data is inadequate conclusions can be biased. Department of Pharmacology, Use of secondary data for research purposes therefore requires a reasonable degree of Winslowparken 19, University 3,4 of Southern Denmark, Odense University accuracy and completeness. Hospital, DK-5000 Odense C, Denmark It is very convenient to use secondary data sources in Denmark because there are + Tel 45 6550 3678 many population-based databases which can be linked via a unique civil registration Fax +45 6591 6089 Email [email protected] number. Several studies have validated Danish databases. Although many of them Clinical Epidemiology 2009:1 27–32 27 © 2009 Andersen et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. Powered by TCPDF (www.tcpdf.org) 1 / 1 Andersen et al have reported good data quality,3,5–8 data quality can differ The surgical procedure codes are assigned by the operating between different diagnoses in the same database.5,7,9–12 To surgeon immediately after operation. our knowledge there is only one study evaluating surgical procedure coding in the Danish National Vascular Registry.13 The Danish National Registry of Patients It was designed as a reproducibility study of the data The Danish National Registry of Patients was established regarding two surgical procedures. The authors found good in 1977 and records 99.4% of all nonpsychiatric hospital reproducibility of the surgical procedure coding, but a study admissions in Denmark.11,16,18 Since 1995 it has also examining the completeness of the Danish National Vascular included data on outpatient and emergency clinic patients. Registry has not yet been conducted. Reporting to the Danish National Registry of Patients is The purpose of the present study, therefore, is to evaluate mandatory and it contains data on patients including their completeness and positive predictive value of the Danish civil registration number, hospital and department, dates of National Vascular Registry regarding registration of the admission and discharge, surgical procedures performed surgical procedures: embolectomy in the brachial, ulnar, or using the Danish Classifi cation of Surgical Procedures radial artery. or the Nordic Classifi cation of Surgical Procedures cod- ing system, and one or several discharge diagnoses using Methods the International Classifi cation of Diseases, 8th Revision Study population (ICD-8) or the International Classifi cation of Diseases, 10th The study was based on fi rst-time embolectomies in the Revision (ICD-10). All discharge diagnoses are assigned by upper limb performed in Denmark from January 1, 1990 to the discharging physician. December 31, 2002. During the study period the total popula- tion of the country increased from about 5.1 to 5.4 millions. The Danish Civil Registration System Data about the background population were uploaded from All citizens in Denmark are assigned a unique 10-digit code, 14 given to each individual having, or having had an address in For personal use only. Statistics Denmark. The health care system in Denmark was, during the period studied, tax-fi nanced, nonprofi t and Denmark since April 1968.17 Data are stored in the Danish free of charge for all inhabitants. Civil Registration System containing electronic records of any change in, as an example, vital and emigration status in Data sources the Danish population. The data were primarily retrieved from the Danish National Vascular Registry and secondarily from the Danish National Record review Registry of Patients. We used a record of fi rst embolectomy To identify subjects we used the surgical procedures in the brachial, ulnar, or radial artery performed in the period embolectomy in brachial, ulnar, or radial artery, coded from 1990 to 2002 to identify our cases.15,16 Emigration and according to the Danish Classifi cation of Surgical Procedures Clinical Epidemiology downloaded from https://www.dovepress.com/ by 54.70.40.11 on 14-Dec-2018 vital status can be followed in the Danish Civil Registration (codes: 86823 and 86824) or the Nordic Classifi cation of System using the patients’ unique civil registration Surgical Procedures (codes PBE20 and PBE30). We decided number.17 to evaluate those two diagnoses jointly, since the embolus can often be found in all three arteries at the same time. The Danish National Vascular Registry After having identified our subjects, we retrieved The Danish National Vascular Registry was initiated in 1989 their medical records from 30 Danish hospitals, of which at the University Hospital of Copenhagen, Rigshospitalet, and 10 have departments of vascular surgery. Records were over the following years it was accepted by other vascular reviewed by experienced clinicians in cardiovascular departments and became a national registry.15 The purpose of medicine (LA, LF). Review data were collected using a the registry is quality-monitoring of procedures. Information detailed standardized form. Embolectomy in brachial, in the Danish National Vascular Registry includes patients’ ulnar, or radial artery was considered confi rmed when the civil registration numbers, admission to hospitals and depart- reviewer verifi ed a description of the surgical procedure ments, dates of admission and discharge, and surgical proce- in the medical record. dures using the Danish Classifi cation of Surgical Procedures The study was approved by the National Board of Health, (until December 31, 1995) or the Nordic Classifi cation of the Danish Data Protection Agency, and the heads of the Surgical Procedures (from January 1, 1996) coding system. clinical departments. 28 Clinical Epidemiology 2009:1 Powered by TCPDF (www.tcpdf.org) 1 / 1 Completeness and positive predictive value of registration Analysis Table 1 Two-source capture–recapture method We linked records from the different registries by using the NRP civil registration number. In one case the same operation was NVR Registered cases Nonregistered registered twice under different civil registration numbers in Registered cases a = 954 b = 35 a + b the Danish National Vascular Registry. One obviously errone- Nonregistered c = 149 d = (5) c + d ous record among these was therefore deleted from the study. a + cb + d Subjects, whose medical records could not be retrieved for Notes: Cell numbers present cases with an operation of upper limb
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