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. 2017 Sep 18;17(1):666.
doi: 10.1186/s12913-017-2612-6.

Moderate sensitivity and high specificity of emergency department administrative data for transient ischemic attacks

Amy Y X Yu  1 , Hude Quan  2 , Andrew McRae  3 , Gabrielle O Wagner  4 , Michael D Hill  5 , Shelagh B Coutts  6
Affiliations

Moderate sensitivity and high specificity of emergency department administrative data for transient ischemic attacks

Amy Y X Yu et al. BMC Health Serv Res. .

Abstract

Background: Validation of administrative data case definitions is key for accurate passive surveillance of disease. Transient ischemic attack (TIA) is a condition primarily managed in the emergency department. However, prior validation studies have focused on data after inpatient hospitalization. We aimed to determine the validity of the Canadian 10th International Classification of Diseases (ICD-10-CA) codes for TIA in the national ambulatory administrative database.

Methods: We performed a diagnostic accuracy study of four ICD-10-CA case definition algorithms for TIA in the emergency department setting. The study population was obtained from two ongoing studies on the diagnosis of TIA and minor stroke versus stroke mimic using serum biomarkers and neuroimaging. Two reference standards were used 1) the emergency department clinical diagnosis determined by chart abstractors and 2) the 90-day final diagnosis, both obtained by stroke neurologists, to calculate the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the ICD-10-CA algorithms for TIA.

Results: Among 417 patients, emergency department adjudication showed 163 (39.1%) TIA, 155 (37.2%) ischemic strokes, and 99 (23.7%) stroke mimics. The most restrictive algorithm, defined as a TIA code in the main position had the lowest sensitivity (36.8%), but highest specificity (92.5%) and PPV (76.0%). The most inclusive algorithm, defined as a TIA code in any position with and without query prefix had the highest sensitivity (63.8%), but lowest specificity (81.5%) and PPV (68.9%). Sensitivity, specificity, PPV, and NPV were overall lower when using the 90-day diagnosis as reference standard.

Conclusions: Emergency department administrative data reflect diagnosis of suspected TIA with high specificity, but underestimate the burden of disease. Future studies are necessary to understand the reasons for the low to moderate sensitivity.

Keywords: Administrative data; Diagnosis; Emergency department; Epidemiology; Transient ischemic attack.

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Conflict of interest statement

Ethics approval and consent to participate

The SPECTRA and DOUBT studies received approval from the University of Calgary institutional review board for research using human subjects and written informed consent was obtained from all patients enrolled. The current study received approval from the University of Calgary institutional review board for research and a waiver of consent was granted (REB15–2943).

Consent for publication

N/A

Competing interests

The authors declare that they have no competing interests.

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References

    1. Reeves M, Khoury J, Alwell K, Moomaw C, Flaherty M, Woo D, Khatri P, Adeoye O, Ferioli S, Kissela B, et al. Distribution of National Institutes of Health stroke scale in the Cincinnati/northern Kentucky stroke study. Stroke. 2013;44(11):3211–3213. doi: 10.1161/STROKEAHA.113.002881. - DOI - PMC - PubMed
    1. Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000;284(22):2901–2906. doi: 10.1001/jama.284.22.2901. - DOI - PubMed
    1. Hill MD, Yiannakoulias N, Jeerakathil T, Tu JV, Svenson LW, Schopflocher DP. The high risk of stroke immediately after transient ischemic attack: a population-based study. Neurology. 2004;62(11):2015–2020. doi: 10.1212/01.WNL.0000129482.70315.2F. - DOI - PubMed
    1. Amarenco P, Lavallee PC, Labreuche J, Albers GW, Bornstein NM, Canhao P, Caplan LR, Donnan GA, Ferro JM, Hennerici MG, et al. One-year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med. 2016;374(16):1533–1542. doi: 10.1056/NEJMoa1412981. - DOI - PubMed
    1. Coutts SB, Modi J, Patel SK, Aram H, Demchuk AM, Goyal M, Hill MD. What causes disability after transient ischemic attack and minor stroke?: results from the CT and MRI in the triage of TIA and minor cerebrovascular events to identify high risk patients (CATCH) study. Stroke. 2012;43(11):3018–3022. doi: 10.1161/STROKEAHA.112.665141. - DOI - PubMed

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