Table 4.
Validation of diagnoses in the Swedish Inpatient Register by sensitivity
| Diagnosis | Proportion identified through the IPR (%) (sensitivity) | Comment | Main Author | PubMed ID | Year | Gold Standard (Reference) |
|---|---|---|---|---|---|---|
| Cardiovascular disease | ||||||
| Myocardial Infarction (MI) | 54/59 (91.5) | Cross-sectional, 1-year retrospective study. ≥20 year-olds from Degerfors area. | Elo [14] | 19084244 | 2009 | Data were obtained from IPR, hospital-based outpatient care and primary health care |
| Myocardial infarction | 99/128 (77) | Merlo [63] | 10870938 | 2000 | Men born 1914 | |
| Myocardial infarction | 113/144 (79) | Merlo [63] | 10870938 | 2000 | The Skaraborg Hypertension Study | |
| Myocardial Infarction | 3201/4148 (77.2) | The researchers identified all MIs in Stockholm county in 1973 through the local IPR and the national Cause of Death Register (restricted to individuals living in Stockholm). | Ahlbom [64] | 721364 | 1978 | Swedish Cause of Death Register |
| Myocardial infarction | 4746/5832 (81.4) of MI cases in community registers were found in IPR or the Cause of Death Register. | IPR and Cause of Death Register data from 1972-1981 for regions with IPR registers at the time. 81% of cases in community registers were found in IPR or Cause of Death Register. Meanwhile 85% of cases in IPR and the Cause of Death Register were found in Community registers (disregarding non-matching fatal cases). | Hammar [65] | 2066207 | 1991 | Community registers with myocardial infarctions |
| Angina Pectoris | 86/196 (43.9) | Cross-sectional, 1-year retrospective study. ≥20 year-olds from Degerfors area. | Elo [14] | 19084244 | 2009 | Data were obtained from IPR, hospital-based outpatient care and primary health care |
| Acute coronary syndrome (MI or unstable angina pectoris) | IPR from emergency department missed 2% of 218 patients with acute coronary syndrome. | Discharge diagnoses from emergency department, Lund University Hospital. | Forberg [66] | 18804783 | 2009 | MR. The study evaluates different methods to identify acute coronary syndrome in patients, using information not available in the IPR (e.g. ECG measurements). |
| Non-specified ischemic heart disease | 44/206 (21.4) | Cross-sectional, 1-year retrospective study. ≥20 year-olds from Degerfors area. | Elo [14] | 19084244 | 2009 | Data were obtained from IPR, hospital-based outpatient care and primary health care |
| Stroke (non-subarachnoidal hemorrhage) | 318/377 (84.4) | Data from a local stroke incidence study at the Örebro University Hospital. | Appelros | - | (PC, Feb 22) | Local stroke incidence study |
| Non-fatal strokes | 3492/3732 (93.6) of all cases 3492/3562 (98.0) of estimated hospital cases |
Patients aged 25-74 years in 1985-89. Criteria for acute stroke from MONICA study were comparable to WHO criteria. | Stegmayr [38] | 1291884 | 1992 | MONICA-population based stroke register |
| Stroke | 75/79 (95) | Merlo [63] | 10870938 | 2000 | The Skaraborg Hypertension Study | |
| Stroke | 76/81 (94) | Merlo [63] | 10870938 | 2000 | "Men born 1914" | |
| Stroke | 384/456 (84.2) | First-time stroke. Restricted to the Lund county. | Hallström [67] | 17156265 | 2007 | * |
| Stroke/Transient ischemic A. | 217/232 (93.5) | ULSAM. | Wiberg | - | (PC, Feb 12) | ULSAM |
| Hypertension | 5,886/42,796 (13.7) | IPR data from the county Östergötland. | Wiréhn [68] | 17786807 | 2007 | County registers of primary health care, outpatient hospital care and inpatient care |
| Hypertension | 74/838 (8.8) | Cross-sectional, 1-year retrospective study. ≥20 year-olds from Degerfors area. | Elo [14] | 19084244 | 2009 | Data were obtained from IPR, hospital-based outpatient care and primary health care |
| Gestational hypertension |
108/166 (65.1) | Zetterström | - | (PC, March 3) | All pregnant women in Sweden have their blood pressure examined. | |
| Lipid disorders | 19/186 (10.2) | Cross-sectional, 1-year retrospective study. ≥20 year-olds from Degerfors area. | Elo [14] | 19084244 | 2009 | Data were obtained from IPR, hospital-based outpatient care and primary health care |
| Autoimmune/immune-mediated diseases | ||||||
| Rheumatoid arthritis (RA) | 489/1150 (42.5) | Malmö, Sweden, 1990-1994. According to the RA criteria of the American College of Rheumatology [41]. | Turesson [42] | 10461483 | 1999 | Data from all rheumatologists and general practictioners in Malmö city, 1997 |
| Diabetes, type 1 and 2* | 92/394 (23.3) | Cross-sectional, 1-year retrospective study. ≥20 year-olds from Degerfors area. | Elo [14] | 19084244 | 2009 | Data were obtained from IPR, hospital-based outpatient care and primary health care |
| Type 1 and type 2 diabetes mellitus * | 349/436 (80.0) patients with diabetes in "source 1" could be identified in the IPR | The researchers evaluated the presence of type 1 or type 2 diabetes among patients with atrial fibrillations at the Södersjukhuset Hospital. All but 8 patients in this validation had type 2 diabetes. | Friberg | - | (PC, Feb 8) | MR + biochemistry data + data on insulin or other medication against diabetes |
| Type 1 and type 2 diabetes mellitus* | 4,348/18,134 (24.0) | IPR data from the county Östergötland. | Wiréhn [68] | 17786807 | 2007 | County registers of primary health care, outpatient hospital care and inpatient care |
| Both type 1/2 diabetes and foot ulcer | 235/280 (83.9) admissions could be identified through the IPR | Based on 117 patients with deep foot infections and type 1 or 2 diabetes, referred to multidisciplinary foot-care team. Specificity for foot ulcers and concomitant diabetes was 98%. | Ragnarson- Tennvall [46] | 11123504 | 2000 | MR |
| Infectious disease | ||||||
| CNS infection in intensive care | ICD-9: 21/22 (95.4) ICD-10: 21/28 (75.0) |
Specificity was 99.6% (ICD-9) and 99.7% (ICD-10). IPR data obtained through both primary and secondary diagnoses. | Gedeborg [69] | 17208121 | 2007 | ICU database diagnoses as reference |
| Pneumonia in intensive care | ICD-9: 89/185 (48.1) ICD-10: 116/221 (52.5) |
Specificity was 95.9% (ICD-9) and 95.8% (ICD-10). IPR data obtained through both main and secondary diagnoses. Using only primary diagnoses for pneumonia the specificity increased slightly but the sensitivity decreased to 31.2% and 38.2% respectively. |
Gedeborg [69] | 17208121 | 2007 | ICU database diagnoses as reference |
| Sepsis in intensive care | ICD-9: 85/186 (45.7) ICD-10: 94/179 (52.5) |
Specificity was 97.5% (ICD-9) and 92.6% (ICD-10). IPR data obtained through both main and secondary diagnoses. | Gedeborg [69] | 17208121 | 2007 | ICU database diagnoses as reference, with inclusion in sepsis trials (IST) as secondary reference |
| Tuberculosis | 12/15 (80) | Evaluation in patients with concomitant rheumatoid arthritis | Askling [70] | 15986370 | 2005 | MR |
| Other disorders | ||||||
| Carotid, infrainguinal bypass and aortic aneurysm (AAA) procedures | 10,861/11,638 (93.3) of patients identified through Swedvasc (Svenska kärlregistret) or the IPR could be identified in the IPR | (Swedvasc) started in 1987 and became nationwide 1994. In the paper by Troëng et al data on infraingunal and carotid bypass originated from 5 years (2000-2004), while data on aortic aneurysms originated from 1 year (2006). Divided the sensitivity figures were: Carotid 96.8%; Infrainguinal 92.3% and aortic aneurysm 88.9%. | Troëng [15] And by |
18851920 | 2008 | The Swedish Vascular Register (Swedvasc) |
| Asthma | 1,377/18,451 (7.5) | IPR data from the county Östergötland. | Wiréhn [68] | 17786807 | 2007 | County registers of primary health care, outpatient hospital care and inpatient care |
| Dementia | 23/87 (26) | Participants originated from the study "Aging in women and men: a longitudinal study of gender differences in health behaviour and health among the elderly (as part of the Swedish Twin Register). The specificity for dementia was 97% (399/411) | Dahl [71] | 18007116 | MR + memory test scores etc. | |
| Dementia | 41.3% for prevalent cases and 42.3% for incident cases. | Participants originated from the study "Aging in women and men: a longitudinal study of gender differences in health behaviour and health among the elderly (as part of the Swedish Twin Register). The specificity for dementia was 97% (399/411) | Rizutto | (PC, May 14) | Comparison between cases detected in IPR with cases derived from the Kungsholmen (KP) and SNAC-K Projects [72] | |
| Foot ulcer (only) | 249/280 (88.9%) of admissions could be identified through the IPR | Based on 117 patients with deep foot infections and type 1 or 2 diabetes, referred to multidisciplinary foot-care team. | Ragnarson- Tennvall [46] | 11123504 | 2000 | MR |
| Chronic obstructive pulmonary disease | 1,290/4,812 (26.8) | IPR data from the county Östergötland. | Wiréhn [68] | 17786807 | 2007 | County registers of primary health care, outpatient hospital care and inpatient care |
PC, Personal communication: All personal communications took place in 2010 (exact date is listed in the table).
ICU, Intensive Care Unit. MI, Myocardial Infarction. MR, compared with Medical Records (patient charts). RA, Rheumatoid arthritis.
ULSAM, Uppsala Longitudinal Study of Adult Men) cohort.
*Data from all departments at the Lund Hospital including the emergency unit, general practitioners, community nurses, physicians at the Neurology department, autopsy registers, Forensic department, computerized searches of outpatient medical records