Identifying cases of spinal cord injury or disease in a primary care electronic medical record database

To identify cases of spinal cord injury or disease (SCI/D) in an Ontario database of primary care electronic medical records (EMR).

A reference standard of cases of chronic SCI/D was established via manual review of EMRs; this reference standard was used to evaluate potential case identification algorithms for use in the same database.

Electronic Medical Records Primary Care (EMRPC) Database, Ontario, Canada.

A sample of 48,000 adult patients was randomly selected from 213,887 eligible patients in the EMRPC database.

N/A.

Candidate algorithms were evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F-score.

126 cases of chronic SCI/D were identified, forming the reference standard. Of these, 57 were cases of traumatic spinal cord injury (TSCI), and 67 were cases of non-traumatic spinal cord injury (NTSCI). The optimal case identification algorithm used free-text keyword searches and a physician billing code, and had 70.6% sensitivity (61.9-78.4), 98.5% specificity (97.3-99.3), 89.9% PPV (82.2-95.0), 94.7% NPV (92.8-96.3), and an F-score of 79.1.

Identifying cases of chronic SCI/D from a database of primary care EMRs using free-text entries is feasible, relying on a comprehensive case definition. Identifying a cohort of patients with SCI/D will allow for future study of the epidemiology and health service utilization of these patients.