权力有陷:行政数据的 (不) 准确性,用于非手术性治疗尾炎
Aksel D Laudon1, Brendin R Beaulieu-Jones1, Baraka Gitonga2
1Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
The Journal of surgical research
|August 17, 2024
概括
不复杂尾炎的非手术治疗 (NOM) 的行政定义的准确性有限. 研究人员在使用行政数据库来研究NOM有效性时,应该仔细考虑这些限制.
科学领域:
- 医疗信息学 医疗信息学
- 手术结果研究研究.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 不复杂尾炎的非手术治疗 (NOM) 越来越多地被使用.
- 有效性研究通常依赖于使用国际疾病分类 (ICD) 代码的行政定义.
- 这些用于识别NOM的行政定义的准确性需要评估.
研究的目的:
- 评估行政定义的准确性,以识别未经复杂的尾炎接受计划非手术治疗 (NOM) 的患者.
- 为了比较两个不同的行政定义与黄金标准队列的表现.
主要方法:
- 五个美国地区尾炎患者的回顾性审查.
- 训练有素的抽象者记录了最初的治疗计划和临床严重程度.
- 根据ICD代码和手术状态定义了一个黄金标准队列 (外科医生诊断的无并发性尾炎与计划的NOM) 和两个行政队列.
- 将行政定义与黄金标准进行比较.
主要成果:
- 在1224名无并发性尾炎患者中,只有5.9%的患者接受了计划的NOM.
- 定义#1 (最初入院期间没有手术) 显示灵敏度为0.81,PPV为0.87.
- 定义#2 (在0-1日没有手术) 显示灵敏度为0.83,PPV为0.72.
- 黄金标准队列中真正的失败/复发率为23.6%.
结论:
- 识别无并发性尾炎计划非手术治疗的行政定义容易被错误分类.
- 这种错误分类可能会影响使用行政数据库的研究结果的准确性.
- 研究人员应该披露潜在的错误分类效应,并选择平衡敏感性和特异性的定义.
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