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Röhrig EJ, Schenkat H, Hochhausen N, Röhl AB, Derwall M, Rossaint R, Kork F. Comparing Charlson Comorbidity Index Scores between Anesthesiologists, Patients, and Administrative Data: A Prospective Observational Study. J Clin Med 2024; 13:1469. [PMID: 38592678 PMCID: PMC10932213 DOI: 10.3390/jcm13051469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Patients' comorbidities play an immanent role in perioperative risk assessment. It is unknown how Charlson Comorbidity Indices (CCIs) from different sources compare. (2) Methods: In this prospective observational study, we compared the CCIs of patients derived from patients' self-reports and from physicians' assessments with hospital administrative data. (3) Results: The data of 1007 patients was analyzed. Agreement between the CCI from patients' self-report compared to administrative data was fair (kappa 0.24 [95%CI 0.2-0.28]). Agreement between physicians' assessment and the administrative data was also fair (kappa 0.28 [95%CI 0.25-0.31]). Physicians' assessment and patients' self-report had the best agreement (kappa 0.33 [95%CI 0.30-0.37]). The CCI calculated from the administrative data showed the best predictability for in-hospital mortality (AUROC 0.86 [95%CI 0.68-0.91]), followed by equally good prediction from physicians' assessment (AUROC 0.80 [95%CI 0.65-0.94]) and patients' self-report (AUROC 0.80 [95%CI 0.75-0.97]). (4) Conclusions: CCIs derived from patients' self-report, physicians' assessments, and administrative data perform equally well in predicting postoperative in-hospital mortality.
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Affiliation(s)
- Eike J. Röhrig
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (E.J.R.); (N.H.); (A.B.R.); (M.D.); (R.R.)
| | - Henning Schenkat
- Deanery of Studies, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Nadine Hochhausen
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (E.J.R.); (N.H.); (A.B.R.); (M.D.); (R.R.)
| | - Anna B. Röhl
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (E.J.R.); (N.H.); (A.B.R.); (M.D.); (R.R.)
| | - Matthias Derwall
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (E.J.R.); (N.H.); (A.B.R.); (M.D.); (R.R.)
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (E.J.R.); (N.H.); (A.B.R.); (M.D.); (R.R.)
| | - Felix Kork
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (E.J.R.); (N.H.); (A.B.R.); (M.D.); (R.R.)
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Slim Z, Bernatsky S. Z. Slim and S. Bernatsky reply. J Rheumatol 2020; 47:781. [PMID: 32062609 DOI: 10.3899/jrheum.200026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Zeinab Slim
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre
| | - Sasha Bernatsky
- Professor of Medicine, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
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D'Amico D, Sansone E, Grazzi L, Giovannetti AM, Leonardi M, Schiavolin S, Raggi A. Multimorbidity in patients with chronic migraine and medication overuse headache. Acta Neurol Scand 2018; 138:515-522. [PMID: 30107027 DOI: 10.1111/ane.13014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/01/2018] [Accepted: 08/10/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Patients with chronic migraine (CM) display a considerable amount of comorbidities, particularly psychiatric and cardiovascular, and the presence of multiple comorbidities, that is, the so-called multimorbidity, is a risk factor for migraine chronification or maintenance of CM. Our aim was to address the rate and impact of multimorbidity in patients with CM and medication overuse headache (MOH). MATERIALS & METHODS In a sample of patients with CM attending a structured withdrawal for coexisting MOH, we defined multimorbidity as the presence of two or more conditions in addition to CM-MOH. We compared patients with and without multimorbidity for demographic and clinical variables, quality of life, and disability; we also tested whether patients with multimorbidity had higher likelihood to attend emergency room, relapse into CM, and require further withdrawal treatments by 12 months. RESULTS One hundred and ninety-four patients were enrolled as follows: 61% had at least one comorbidity, the most common being mental (34%), circulatory (18%), and endocrine conditions (13%); 32% were multimorbidity cases. Patients with multimorbidity had higher headaches frequency, older age, lower education and lower employment rates, higher disability and lower QoL. They were more frequently opioids/barbiturates overusers and were more likely to attend ER (OR: 2.36), relapse into CM (OR: 2.19), and undergo another withdrawal (OR: 2.75) by 12 months after discharge, after controlling for age, gender, years of education, and headache frequency. CONCLUSIONS Recognizing multimorbidity in patients with CM-MOH is important to enhance the management of these complex patients, who are at risk of polypharmacy and increased health care utilization.
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Affiliation(s)
- Domenico D'Amico
- Neuroalgology Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Emanuela Sansone
- Neuroalgology Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Licia Grazzi
- Neuroalgology Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Ambra M. Giovannetti
- Unit of Neuroepidemiology; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
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Lo T, Parkinson L, Cunich M, Byles J. Discordance between self-reported arthritis and musculoskeletal signs and symptoms in older women. BMC Musculoskelet Disord 2016; 17:494. [PMID: 27905906 PMCID: PMC5133957 DOI: 10.1186/s12891-016-1349-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/23/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Arthritis is a gendered disease where women have a higher prevalence and more disability than men with arthritis of the same age. Health survey data is a major source of information for monitoring of the burden of arthritis. The validity of self-reported arthritis and the determinants of its accuracy among women have not been thoroughly studied. The objectives of this study were to: 1) examine the agreement between self-report diagnosed arthritis and musculoskeletal signs and symptoms in community-living older women; 2) estimate the sensitivity, specificity, and predictive values of self-reported arthritis; and 3) assess the factors associated with the disagreement. METHODS A cross-sectional survey of women was undertaken in 2012-13. The health survey asked women about diagnosed arthritis and musculoskeletal signs and symptoms. Agreement between self-reported arthritis and musculoskeletal signs symptoms was measured by Cohen's kappa. Sensitivity, specificity, and predictive values of self-reported arthritis were estimated using musculoskeletal signs and symptoms as the reference standard. Factors associated with disagreement between self-reported arthritis and the reference standard were examined using multiple logistic regression. RESULTS There were 223 participants self-reported arthritis and 347 did not. A greater number of participants who self-reported arthritis were obese compared to those who did not report arthritis. Those who reported arthritis had worse health, physical functioning, and arthritis symptom measures. Among the 570 participants, 198 had musculoskeletal signs and symptoms suggesting arthritis (the reference standard). Agreement between self-reported arthritis and the reference standard was moderate (kappa = 0.41). Sensitivity, specificity, and positive and negative predictive values of self-reported arthritis in older women were 66.7, 75.5, 59.2, and 81.0% respectively. Regression analysis results indicated that false-positive is associated with better health measured by the Short Form 36 physical summary score, the Health Assessment Questionnaire disability index, or the Western Ontario and McMaster University Osteoarthritis Index total score; whereas false-negative is negatively associated with these variables. CONCLUSION While some women who reported diagnosed arthritis did not have recent musculoskeletal signs or symptoms, others with the signs and symptoms did not report diagnosed arthritis. Researchers should use caution when employing self-reported arthritis as the case-definition in epidemiological studies.
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Affiliation(s)
- Tkt Lo
- Research Centre for Gender, Health and Ageing, HMRI, University of Newcastle, C/- University Drive, Callaghan, NSW, 2308, Australia.
| | - Lynne Parkinson
- Central Queensland University, Rockhampton, QLD, 4701, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Michelle Cunich
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, 2006, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Julie Byles
- Research Centre for Gender, Health and Ageing, HMRI, University of Newcastle, C/- University Drive, Callaghan, NSW, 2308, Australia
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Widdifield J, Labrecque J, Lix L, Paterson JM, Bernatsky S, Tu K, Ivers N, Bombardier C. Systematic Review and Critical Appraisal of Validation Studies to Identify Rheumatic Diseases in Health Administrative Databases. Arthritis Care Res (Hoboken) 2013; 65:1490-503. [DOI: 10.1002/acr.21993] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 02/13/2013] [Indexed: 01/15/2023]
Affiliation(s)
| | | | - Lisa Lix
- University of Manitoba, Winnipeg; Manitoba; Canada
| | - J. Michael Paterson
- University of Toronto, Toronto, Institute for Clinical Evaluative Sciences, Toronto, and McMaster University, Hamilton; Ontario; Canada
| | | | - Karen Tu
- University of Toronto and Institute for Clinical Evaluative Sciences, Toronto; Ontario; Canada
| | - Noah Ivers
- University of Toronto and Women's College Hospital, Toronto; Ontario; Canada
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Good agreement between self-report and centralized hospitalizations data for arthritis-related surgeries. J Clin Epidemiol 2013; 66:1128-34. [PMID: 23845185 DOI: 10.1016/j.jclinepi.2013.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 04/10/2013] [Accepted: 04/16/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To examine the level of agreement between self-reported and hospital administration records of arthritis-related surgeries for two large samples of community-dwelling older women in Australia, born between 1921-1926 and 1946-1951. STUDY DESIGN AND SETTING Self-report survey data from the Australian Longitudinal Study on Women's Health was linked to inpatient hospital data from the New South Wales Admitted Patient Data Collection. Levels of agreement were compared using Cohen's kappa, sensitivity, specificity, and positive and negative predictive values. Reasons for false positives were examined. RESULTS This study found good agreement (kappa >0.70; sensitivity and specificity >0.80) between self-report and hospitalizations data for arthritis-related surgeries. CONCLUSIONS This study provides new evidence for good agreement between self-reported health survey data and administrative records of arthritis-related joint procedures, and supports the use of self-report surveys in epidemiological studies of joint procedures where administrative data are either not available or not readily accessible, or where more extensive contextual information is needed. The use of health survey data in conjunction with administrative data has an important role to play in public health planning and policy.
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Gad BV, Higuera CA, Klika AK, Elsharkawy KA, Barsoum WK. Validity of patient-reported comorbidities before total knee and hip arthroplasty in patients older than 65 years. J Arthroplasty 2012; 27:1750-1756.e1. [PMID: 22789447 DOI: 10.1016/j.arth.2012.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 05/06/2012] [Indexed: 02/01/2023] Open
Abstract
Obtaining preoperative medical histories in elderly patients can be challenging, and tools have been developed to aid in history gathering. The purpose of this study is to determine the agreement between patient- and physician-reported histories before total knee or hip arthroplasty. Three hundred eighty-two patients older than 65 years completed a preoperative morbidity assessment form preoperatively. Sensitivity, specificity, κ, and agreement were calculated for each dichotomous response. Diabetes (κ = 0.77) and lung disease (κ = 0.68) had substantial agreement. Fourteen comorbidities ranged from slight to moderate agreement. Osteoarthritis and peripheral vascular disease had no agreement. These results highlight the incongruence between patient- and physician-reported comorbidities and emphasizes the need for detailed histories by health care professionals for medically complicated elderly patients preoperatively.
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Affiliation(s)
- Bishoy V Gad
- Department of Orthopaedic Surgery Orthopaedic and Rheumatologic Institute Cleveland Clinic Cleveland, OH, USA
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Cadieux G, Buckeridge DL, Jacques A, Libman M, Dendukuri N, Tamblyn R. Patient, physician, encounter, and billing characteristics predict the accuracy of syndromic surveillance case definitions. BMC Public Health 2012; 12:166. [PMID: 22397597 PMCID: PMC3378465 DOI: 10.1186/1471-2458-12-166] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 03/08/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syndromic surveillance systems are plagued by high false-positive rates. In chronic disease monitoring, investigators have identified several factors that predict the accuracy of case definitions based on diagnoses in administrative data, and some have even incorporated these predictors into novel case detection methods, resulting in a significant improvement in case definition accuracy. Based on findings from these studies, we sought to identify physician, patient, encounter, and billing characteristics associated with the positive predictive value (PPV) of case definitions for 5 syndromes (fever, gastrointestinal, neurological, rash, and respiratory (including influenza-like illness)). METHODS The study sample comprised 4,330 syndrome-positive visits from the claims of 1,098 randomly-selected physicians working in Quebec, Canada in 2005-2007. For each visit, physician-facilitated chart review was used to assess whether the same syndrome was present in the medical chart (gold standard). We used multivariate logistic regression analyses to estimate the association between claim-chart agreement about the presence of a syndrome and physician, patient, encounter, and billing characteristics. RESULTS The likelihood of the medical chart agreeing with the physician claim about the presence of a syndrome was higher when the treating physician had billed many visits for the same syndrome recently (ORper 10 visit, 1.05; 95% CI, 1.01-1.08), had a lower workload (ORper 10 claims, 0.93; 95% CI, 0.90-0.97), and when the patient was younger (ORper 5 years of age, 0.96; 95% CI, 0.94-0.97), and less socially deprived (ORmost versus least deprived, 0.76; 95% CI, 0.60-0.95). CONCLUSIONS Many physician, patient, encounter, and billing characteristics associated with the PPV of surveillance case definition are accessible to public health, and could be used to reduce false-positive alerts by surveillance systems, either by focusing on the data most likely to be accurate, or by adjusting the observed data for known biases in diagnosis reporting and performing surveillance using the adjusted values.
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Affiliation(s)
- Geneviève Cadieux
- Department of Epidemiology and Biostatistics, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada.
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Schmajuk G, Chakravarty EF. Arthritis: in the eye of the beholder? J Rheumatol 2009; 36:1858-1860. [PMID: 19738206 DOI: 10.3899/jrheum.090609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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