The Positive Predictive Value of Pediatric Stroke Diagnoses in Administrative Data: A Retrospective Validation Study

Figures & data

Table 1 The Positive Predictive Value (PPV) of TIA and Stroke Diagnoses in the Danish National Registry of Patients

Diagnosis Registered in the DNRP	Number	Diagnosis According to Medical Record Review									PPV (95% CI)
		SAH	ICH	AIS	Unspecified Stroke	Stroke Due to CVT	TIA	Traumatic Intracranial Hemorrhage	Other Cerebrovascular Diseases	Non-Cerebrovascular Diseases
SAH (I60)	30	–	1	1	–	–	–	20	–	8	0.07	0.01–0.22
ICH (I61-62)	107	1	40	3	1	–	–	39	8	15	0.42	0.33–0.52
AIS (I63 excl. I63.6)	54	–	–	45	–	–	–	1	1	7	0.83	0.71–0.92
Unspecified stroke (I64)	28	–	2	14	–	–	1	–	–	11	0.57	0.37–0.76
CVT (I63.6, I67.6, I676A, DG08)	13	–	–	–	–	4	–	–	7	2	0.31	0.09–0.61
TIA (DG45)	34	–	–	3	–	–	3	–	–	28	0.09	0.02–0.24
Other cerebrovascular diseases (I67-I68, excl I67.6 and I676A)	43	–	1	4	–	–	–	1	17	20	0.12	0.04–0.25
All (I60-64, I67-68, DG08, DG45)	309	1	44	70	1	4	4	61	33	91	0.39	0.33–0.45

Note: Data presented for consensus validation in accordance with the stroke definition from the American Heart and American Stroke Association.

Abbreviations: AIS, arterial ischemic stroke; CVT, central venous thrombosis; DNPR, Danish National Registry of Patients; ICH, intracerebral hemorrhage; SAH, subarachnoid hemorrhage; TIA, transient ischemic attack.

Table 2 The Positive Predictive Values (PPV) and Use of Neuroimaging in Subgroups of Children (0–17 Years) in the Danish National Patient Registry (DNPR)

	All, n	Neuroimaging, n(%)	CT, N(%)	MRI, n(%)	PPV, 95% CI
Age-group
1–11 months	37	32(86.5)	27(73.0)	17(45.9)	0.30 (0.16–0.47)
1–5 years	57	56(98.2)	43(75.4)	37(64.9)	0.61 (0.48–0.74)
6–12 years	81	77(95.1)	48(59.3)	56(69.1)	0.42 (0.31–0.54)
13–17 years	134	120(89.6)	78(58.2)	78(58.2)	0.30 (0.22–0.38)
Sex
Female	130	118(90.8)	75(57.7)	84(64.6)	0.31 (0.23–0.40)
Male	179	167(93.3)	121(67.6)	104(58.1)	0.45 (0.37–0.52)
Study-period
2017	82	72(87.8)	42(51.2)	50(61.0)	0.37 (0.26–0.48)
2018	87	78(89.7)	55(63.2)	52(59.8)	0.38 (0.28–0.49)
2019	69	67(97.1)	49(71.0)	42(60.9)	0.44 (0.32–0.56)
2020	71	68(95.8)	50(70.4)	44(62.0)	0.38 (0.27–0.50)
Diagnosis in The DNRP
SAH (I60)	30	29(96.7)	26(86.7)	6(20.0)	0.07 (0.01–0.22)
ICH (I61-62)	107	104(97.2)	91(85.0)	44(41.1)	0.42 (0.33–0.52)
AIS (I63 excl I63.6)	54	54(100)	36(66.7)	48(88.9)	0.83 (0.71–0.92)
Unspecified stroke (I64)	28	25(89.3)	14(50.0)	23(82.1)	0.57 (0.37–0.76)
CVT (I63.6, I67.6, DG08)	13	13(100)	9(69.2)	12(92.3)	0.31 (0.09–0.61)
TIA (DG45)	34	24(70.6)	5(14.7)	23(67.6)	0.09 (0.02–0.24)
Other cerebrovascular diseases (Di67-68 EXCL. 67.6)	43	36(83.7)	15(34.9)	32(74.4)	0.12 (0.04–0.25)

Note: Data presented for consensus validation according to the stroke definition from the American Heart and American Stroke Association.

Abbreviations: AIS, arterial ischemic stroke; CVT, central venous thrombosis; DNPR, Danish National Registry of Patients; ICH, intracerebral hemorrhage; SAH, subarachnoid hemorrhage; TIA, transient ischemic attack.

Table 3 Interrater Reliability for Stroke Subtypes

Stroke Subtype	N	PPV (95% CI)		Kappa (95% CI)
		Assessor 1	Assessor 2
SAH (I60)	30	0.03 (0.001–0.17)	0.10 (0.02–0.27)	0.47 (−0.13–1.0)
ICH (I61-62)	107	0.40 (0.31–0.50)	0.44 (0.34–0.54)	0.89 (0.80–0.97)
AIS (I63 excl. I63.6)	54	0.74 (0.60–0.85)	0.83 (0.71–0.92)	0.73 (0.51–0.95)
Unspecified stroke (I64)	28	0.54 (0.34–0.73)	0.54 (0.34–0.73)	0.86 (0.66–1.0)
CVT (I63.6, I67.6, I676A, DG08)	13	0.31 (0.09–0.61)	0.39 (0.14–0.68)	0.83 (0.52–1.0)
TIA (DG45)	34	0.09 (0.02–0.24)	0.06 (0.01–0.20)	0.78 (0.38–1.0)
Other cerebrovascular diseases (I67-I68, excl I67.6 and I676A)	43	0.12 (0.04–0.25)	0.14 (0.05–0.28)	0.48 (0.09–0.87)
All (I60-64, I67-68, DG45, DG08)	309	0.36 (0.31–0.42)	0.40 (0.34–0.46)	0.85 (0.79–0.91)

Note: Validation based on the stroke definition from American Heart and American Stroke Association.

Abbreviations: AIS, arterial ischemic stroke; CI, confidence interval; CVT, central venous thrombosis; ICH, intracerebral hemorrhage; PPV, positive predictive value; SAH, subarachnoid hemorrhage; TIA, transient ischemic attack.

Table 4 The Positive Predictive Value (PPV) of Stroke Discharge Diagnoses in the Danish National Registry of Patients According to Different Stroke Definitions

Diagnosis Registered in the DNRP	N	PPV (95% CI) by Stroke Definition			P value
		AHA/ASA	ICD-11	WHO
SAH (I60)	30	0.07 (0.01–0.22)	0.03 (0.00–0.17)	0.03 (0.00–0.17)	0.368
ICH (I61-62)	107	0.42 (0.33–0.52)	0.40 (0.31–0.50)	0.36 (0.27–0.45)	0.004
AIS (I63 excl. I63.6)	54	0.83 (0.71–0.92)	0.61 (0.47–0.74)	0.54 (0.40–0.67)	<0.001
Unspecified stroke (I64)	28	0.57 (0.37–0.76)	0.50 (0.31–0.69)	0.39 (0.22–0.59)	0.022
TIA (DG45)	34	0.09 (0.02–0.24)	0.09 (0.02–0.24)	0.06 (0.01–0.20)	0.368
Other cerebrovascular diseases (I67-I68, excl I67.6 and I676A)	43	0.12 (0.04–0.25)	0.12 (0.04–0.25)	0.09 (0.03–0.22)	0.368
All (I60-64, I67-68, DG45, DG08 excl. I63.6, I67.6 and I676A)^†	296	0.39 (0.34–0.45)	0.33 (0.28–0.39)	0.29 (0.24–0.34)	<0.001

Notes: ^†Overall PPV calculated with exclusion of children registered with CVT (n=13) since this diagnosis is not considered a stroke across all of the tested stroke definitions. Comparison Calculated for Children Registered with SAH, ICH, AIS, Unspecified Stroke, TIA and Other Cerebrovascular Diseases (n=296).

Abbreviations: AIS, arterial ischemic stroke; ICH, intracerebral hemorrhage; SAH, subarachnoid hemorrhage.

Data Sharing Statement

The data that support the findings of this study are available on request from the corresponding author (JBB). The data are not publicly available as their containing information could compromise the privacy of research participants.