Positive Predictive Value of Non-Traumatic Bleeding Diagnoses in the Danish National Patient Register

Abstract

Purpose

The majority of bleeding diagnoses in the Danish National Patient Registry have not been validated despite extensive use in epidemiological research. Therefore, we examined the positive predictive value (PPV) of non-traumatic bleeding diagnoses in the Danish National Patient Registry.

Study Design

Population-based validation study.

Patients and Methods

Based on a manual review of electronic medical records, we estimated the PPV of diagnostic coding (International Classification of Diseases, Tenth Revision (ICD‐10)) for non-traumatic bleeding for all patients ≥65 years of age with any hospital contact in the North Denmark Region during March–December 2019 as registered in the Danish National Patient Registry. We calculated PPVs and associated 95% confidence intervals (CI) for non-traumatic bleeding diagnoses overall and stratified according to primary or secondary diagnosis, and according to major anatomical sites.

Results

A total of 907 electronic medical records were available for review. The population mean age was 79.33 years (standard deviation (SD)=7.73) and 57.6% were males. Primary bleeding diagnoses accounted for 766 of the records and 141 were secondary bleeding diagnoses. The overall PPV for bleeding diagnoses was 94.0% (95% CI: 92.3–95.4). The PPV was 98.7% (95% CI: 97.6–99.3) for the primary diagnoses and 68.8% (95% CI: 60.7–75.9) for the secondary diagnoses. When stratified according to subgroups of major anatomical sites, the PPVs ranged between 94.1% and 100% for the primary diagnoses, and between 53.8% and 100% for secondary diagnoses.

Conclusion

The overall validity of non-traumatic bleeding diagnoses in the Danish National Patient Registry is high and considered acceptable for epidemiological research. However, PPVs were substantially higher for primary than for secondary diagnosis.

Keywords:

• bleeding
• epidemiology
• validity
• register-based research

Abbreviations

ATC, Anatomical Therapeutic Chemical; CI, Confidence interval; CT, Computerized tomography; DNPR, Danish National Patient Registry; DK, Denmark; ICD-10, International Classification of Diseases, Tenth Revision; MRI, Magnetic resonance imaging; NDR, North Denmark Region; REDCap, Research Electronic Data Capture; SD, Standard deviation.

Acknowledgments

The Danish Society for Patient Safety and the Danish Patient Safety Authority are acknowledged for support as co-coordinators of the Danish sub-investigation of “Medication without harm” under which this study was conducted. This study was partly funded by grants from the Danish Patient Safety Authority and Henry og Astrid Møller fond. The sponsors did not influence the design or execution of the study.

Disclosure

MT reports grants from Danish Regions and Henry og Astrid Møller fond, during the conduct of the study. PBN has received speaking fees from Daiichi-Sankyo, SERVIER and BMS/Pfizer; consulting fees from Bayer and Daiichi-Sankyo; and grant support from BMS/Pfizer, Bayer, and Daiichi-Sankyo. AEO reports grants from Danish Regions, during the conduct of the study. MBP has received grant support from BETA.HEALTH. TBL has served as an investigator for Janssen Scientific Affairs, LLC, and Boehringer Ingelheim and received speaking and consulting fees from Bayer, Bristol-Myers Squibb/Pfizer, Boehringer Ingelheim, MSD, and AstraZeneca. The authors have no other conflicts of interest to declare.