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Accuracy of identifying acute stroke admissions in a Michigan Stroke Registry
Mathew J Reeves1, Susan Wehner, Natalie Organek
1Department of Epidemiology, B 601 W Fee Hall, Michigan State University, East Lansing, MI 48824, USA. reevesm@msu.edu
Introduction:
The accurate identification of acute stroke cases is an essential requirement of hospital-based stroke registries. We determined the accuracy of acute stroke diagnoses in Michigan hospitals participating in a prototype of the Paul Coverdell National Acute Stroke Registry.
Methods:
From May through November 2002, registry teams (ie, nurse and physician) from 15 Michigan hospitals prospectively identified all suspect acute stroke admissions and classified them as stroke or nonstroke. Medical chart data were abstracted for a random sample of 120 stroke and 120 nonstroke admissions. A blinded independent physician panel then classified each admission as stroke, nonstroke, or unclassifiable, and the overall accuracy of the registry was determined.
Results:
The physician panel reached consensus on 219 (91.3%) of 240 admissions. The panel identified 105 stroke admissions, 93 of which had been identified by the registry teams (sensitivity = 88.6%). The panel identified 114 nonstroke admissions, all of which had been identified as nonstrokes by the registry teams (specificity = 100%). The positive and negative predictive value of the registry teams' designation was 100% and 90.5%, respectively. The registry teams' assessment of stroke subtype agreed with that of the panel in 78.5% of cases. Most discrepancies were related to the distinction between ischemic stroke and transient ischemic attack.
Conclusion:
The accuracy of hospitals participating in a hospital-based stroke registry to identify acute stroke admissions was very good; hospitals tended to underreport rather than to overreport stroke admissions. Stroke registries should periodically conduct studies to ensure that the accuracy of case ascertainment is maintained.
Insights
Hospital stroke registries accurately identify acute stroke cases, demonstrating high sensitivity and specificity. These registries tend to underreport strokes, highlighting the need for ongoing accuracy assessments.
Area of Science:
- Neurology
- Public Health
- Health Informatics
Background:
- Accurate identification of acute stroke cases is crucial for hospital-based stroke registries.
- The Paul Coverdell National Acute Stroke Registry aims to improve stroke care through data collection.
Purpose of the Study:
- To determine the accuracy of acute stroke diagnoses in Michigan hospitals participating in a prototype registry.
- To evaluate the performance of registry teams in identifying stroke and non-stroke admissions.
Main Methods:
- Prospective identification of suspect acute stroke admissions by registry teams in 15 Michigan hospitals.
- Independent physician panel review of a random sample of stroke and non-stroke admissions for classification.
- Calculation of sensitivity, specificity, and predictive values for registry team diagnoses.
Main Results:
- Physician panel reached consensus on 91.3% of admissions.
- Registry teams achieved 88.6% sensitivity and 100% specificity in identifying stroke cases.
- Positive and negative predictive values were 100% and 90.5%, respectively; 78.5% agreement on stroke subtype.
Conclusions:
- Hospital-based stroke registries demonstrate very good accuracy in identifying acute stroke admissions.
- Hospitals participating in the registry tended to underreport stroke cases rather than overreport.
- Periodic accuracy studies are recommended to maintain case ascertainment quality in stroke registries.