Validation of forearm fracture diagnoses in administrative patient registers

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

doi:10.1007/s11657-023-01322-x

Validation of forearm fracture diagnoses in administrative patient registers

Arch Osteoporos. 2023 Aug 24;18(1):111. doi: 10.1007/s11657-023-01322-x.

Authors

Tone Kristin Omsland¹, Lene B Solberg², Åshild Bjørnerem^{3

4

5}, Tove T Borgen⁶, Camilla Andreasen^{4

7}, Torbjørn Wisløff⁸, Gunhild Hagen⁹, Trude Basso¹⁰, Jan-Erik Gjertsen^{11

12}, Ellen M Apalset^{13

14}, Wender Figved^{15

16}, Jens M Stutzer¹⁷, Frida I Nissen^{3

4

7}, Ann K Hansen^{4

7}, Ragnar M Joakimsen^{4

18}, Elisa Figari¹⁹, Geoffrey Peel¹⁹, Ali A Rashid¹⁹, Jashar Khoshkhabari⁴, Erik F Eriksen^{20

21}, Lars Nordsletten^{2

16}, Frede Frihagen^{16

22}, Cecilie Dahl¹⁹

Affiliations

¹ Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Blindern, Po box 1130, 0318, Oslo, Norway. t.k.omsland@medisin.uio.no.
² Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
³ Department of Obstetrics and Gynaecology, University Hospital of North Norway, Tromsø, Norway.
⁴ Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway.
⁵ Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway.
⁶ Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway.
⁷ Department of Orthopaedic Surgery, University Hospital of North Norway, Tromsø, Norway.
⁸ Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
⁹ Department of Health Services, Norwegian Institute of Public Health, Oslo, Norway.
¹⁰ Department of Orthopaedic Surgery, St. Olavs University Hospital, Trondheim, Norway.
¹¹ Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
¹² Department of Clinical Medicine, University of Bergen, Bergen, Norway.
¹³ Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway.
¹⁴ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
¹⁵ Department of Orthopaedic Surgery, Vestre Viken Hospital Trust, Bærum Hospital, Gjettum, Norway.
¹⁶ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
¹⁷ Department of Orthopaedic Surgery, Møre and Romsdal Hospital Trust, Hospital of Molde, Molde, Norway.
¹⁸ Department of Medicine, University Hospital of North Norway, Tromsø, Norway.
¹⁹ Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Blindern, Po box 1130, 0318, Oslo, Norway.
²⁰ Pilestredet Park Specialist Centre, Oslo, Norway.
²¹ Faculty of Dentistry, University of Oslo, Oslo, Norway.
²² Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway.

Abstract

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.

Keywords: Forearm fracture; Positive predictive value; Sensitivity; Validation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Algorithms
Female
Forearm
Forearm Injuries* / diagnosis
Forearm Injuries* / epidemiology
Fractures, Bone*
Hospitals
Humans
Male