Document Detail

Validity of the hospital discharge diagnosis in epidemiologic studies of biliopancreatic pathology. PANKRAS II Study Group.
MedLine Citation:
PMID:  11049097     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The aim was to analyse the magnitude, direction and predictors of change in the main hospital discharge diagnosis (HDD) after a clinical expert review, among patients included in a multicentre molecular epidemiologic study of biliopancreatic diseases. METHODS: A total of 602 patients with a suspicion diagnosis of pancreas cancer (PC), cancer of the extrahepatic biliary system (CEBS) or benign biliopancreatic pathologies (BPP) were prospectively recruited at five general hospitals. A structured form was used to collect information from medical records. A panel of experts revised all diagnostic information and established the main clinicopathological diagnosis (CPD) by consensus. RESULTS: Of the 204 cases with a HDD of PC, 176 (86%) were deemed to have a CPD of PC, eight of CEBS, twelve a neoplasm of different origin, four BPP and four syndromic diagnoses. Thus, 28 cases (14%) were false positives. Of the 129 patients with a HDD of CEBS, 15 (12%) were false positives. Nine of the 396 cases with a HDD of non-PC (2%) had a CPD of PC (false negatives), whilst 14 of 471 patients with a HDD of non-CEBS (3%) were deemed to have CEBS. Overall, sensitivity and specificity of HDD for PC were, respectively, 95 and 93%, and for CEBS, 89 and 97%. Cytohistological confirmation and laparotomy were independent predictors of diagnostic change. CONCLUSIONS: Validity of the HDD was high, but its association with some clinical variables suggests that sole reliance on HDD can significantly bias results, and highlights the need to review all HDDs. Alternatively, only patients at high risk of misdiagnosis could be reviewed: primarily, those lacking a cytohistological diagnosis or a laparotomy. No exclusions appear warranted solely on the basis of age, gender or tumour spread.
M Porta; S Costafreda; N Malats; L Guarner; M Soler; J M Gubern; E García-Olivares; M Andreu; A Salas; J M Corominas; J Alguacil; A Carrato; J Rifà; F X Real
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of epidemiology     Volume:  16     ISSN:  0393-2990     ISO Abbreviation:  Eur. J. Epidemiol.     Publication Date:  2000 Jun 
Date Detail:
Created Date:  2001-01-19     Completed Date:  2001-01-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8508062     Medline TA:  Eur J Epidemiol     Country:  NETHERLANDS    
Other Details:
Languages:  eng     Pagination:  533-41     Citation Subset:  IM    
Institut Municipal d'Investigació Mèdica, Universitat Autònoma de Barcelona, Spain.
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MeSH Terms
Bile Duct Neoplasms / diagnosis*,  epidemiology
Bile Ducts, Extrahepatic / pathology*
Epidemiologic Methods
False Positive Reactions
Health Care Surveys
Medical Records / statistics & numerical data*
Middle Aged
Pancreatic Neoplasms / diagnosis*,  epidemiology
Patient Discharge / statistics & numerical data*
Reproducibility of Results
Spain / epidemiology

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