External review and validation of the Swedish national inpatient register

Ludvigsson, Jonas F.; Andersson, Eva; Ekbom, Anders; Feychting, Maria; Kim, Jeong-Lim; Reuterwall, Christina; Heurgren, Mona; Olausson, Petra Otterblad

doi:10.1186/1471-2458-11-450

Cited by 4,126 publications

(4,470 citation statements)

References 58 publications

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“…The NPR has a near 100 per cent coverage and yields highly valid data, allowing high‐quality longitudinal epidemiological studies on a population basis19. Reliable, detailed population data from Statistics Sweden for standardization and adjustments further reduced potential bias.…”

Section: Discussionmentioning

confidence: 99%

Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013

et al. 2018

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BackgroundThe long‐term incidence of acute appendicitis has been reported to be declining in Europe and North America. Recent reports, however, indicate stabilized or even increased rates. The aim of this study was to investigate the present epidemiology of acute appendicitis and appendicectomy in a population‐based cohort of Swedish children.MethodsThe Swedish National Patient Register was queried for all children with acute appendicitis and/or appendicectomy in 1987–2013. Population‐based incidence rates were calculated. Rates were age‐ and sex‐adjusted, and analysed for temporal and regional trends.ResultsSome 56 774 children with acute appendicitis were identified, of whom 53 478 (94·2 per cent) underwent appendicectomy. The incidence rate of acute appendicitis declined by 43·7 per cent over 26 years, from 177·7 to 100·1 per 100 000 person‐years between 1987 and 2013. The most significant reduction was for non‐perforated appendicitis, from 138·5 to 68·4 per 100 000 person‐years between 1987 and 2009. The incidence rate of perforated appendicitis decreased from 28·0 to 19·9 per 100 000 person‐years and negative appendicectomies reduced from 48·5 to 3·6 per 100 000 person‐years during the study interval.ConclusionThe incidence rates of acute appendicitis and negative appendicectomy have reduced markedly in Swedish children over time, with significantly different trends amongst non‐perforated appendicitis and perforated appendicitis. The full explanation for the observed findings is unclear.

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Section: Discussionmentioning

confidence: 99%

Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013

et al. 2018

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“…The Swedish national inpatient register (IPR) was established in 1965 and has had complete national coverage since 1987 13. More than 99% of all somatic and psychiatric hospital discharges from across Sweden are registered in the inpatient register.…”

Section: Methodsmentioning

confidence: 99%

Development and validation of risk prediction model for venous thromboembolism in postpartum women: multinational cohort study

Sultan

West

Grainge

et al. 2016

BMJ

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109

132

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Objective To develop and validate a risk prediction model for venous thromboembolism in the first six weeks after delivery (early postpartum).Design Cohort study.Setting Records from England based Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES) and data from Sweden based registry.Participants All pregnant women registered with CPRD-HES linked data between 1997 and 2014 and Swedish medical birth registry between 2005 and 2011 with postpartum follow-up.Main outcome measure Multivariable logistic regression analysis was used to develop a risk prediction model for postpartum venous thromboembolism based on the English data, which was externally validated in the Swedish data.Results 433 353 deliveries were identified in the English cohort and 662 387 in the Swedish cohort. The absolute rate of venous thromboembolism was 7.2 per 10 000 deliveries in the English cohort and 7.9 per 10 000 in the Swedish cohort. Emergency caesarean delivery, stillbirth, varicose veins, pre-eclampsia/eclampsia, postpartum infection, and comorbidities were the strongest predictors of venous thromboembolism in the final multivariable model. Discrimination of the model was similar in both cohorts, with a C statistic above 0.70, with excellent calibration of observed and predicted risks. The model identified more venous thromboembolism events than the existing national English (sensitivity 68% v 63%) and Swedish guidelines (30% v 21%) at similar thresholds.Conclusion A new prediction model that quantifies absolute risk of postpartum venous thromboembolism has been developed and externally validated. It is based on clinical variables that are available in many developed countries at the point of delivery and could serve as the basis for real time decisions on obstetric thromboprophylaxis.

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“…The data collected by the NHDR are mandatory for all hospitals to provide—including private, public, and other institutions—for both inpatient and outpatient settings. Although coverage and accuracy of both NHDRs is good (Ludvigsson et al 2011, Sund 2012, Huttunen et al 2014), an internal validity control of the data revealed that 2 hospitals in Stockholm, Sweden had performed approximately 1,800 knee arthroscopies annually for degenerative knee disease or meniscal tears in recent years, whereas the number had doubled in 2012, raising suspicion of double-coding of procedures (Socialstyrelsen 2009, Socialstyrelsen 2014). Thus, due to the potential problems with internal validity, we excluded these 2 hospitals in Stockholm from the analysis with regard to the whole study period (2001—2012).…”

Section: Methodsmentioning

confidence: 99%

Changes in rates of arthroscopy due to degenerative knee disease and traumatic meniscal tears in Finland and Sweden

et al. 2015

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Background and purposeKnee arthroscopy is commonly performed to treat degenerative knee disease symptoms and traumatic meniscal tears. We evaluated whether the recent high-quality randomized control trials not favoring arthroscopic surgery for degenerative knee disease affected the procedure incidence and trends in Finland and Sweden.Patients and methodsWe conducted a bi-national registry-based study including all adult (aged ≥18 years) inpatient and outpatient arthroscopic surgeries performed for degenerative knee disease (osteoarthritis (OA) and degenerative meniscal tears) and traumatic meniscal tears in Finland between 1997 and 2012, and in Sweden between 2001 and 2012.ResultsIn Finland, the annual number of operations was 16,389 in 1997, reached 20,432 in 2007, and declined to 15,018 in 2012. In Sweden, the number of operations was 9,944 in 2001, reached 11,711 in 2008, and declined to 8,114 in 2012. The knee arthroscopy incidence for OA was 124 per 105 person-years in 2012 in Finland and it was 51 in Sweden. The incidence of knee arthroscopies for meniscal tears coded as traumatic steadily increased in Finland from 64 per 105 person-years in 1997 to 97 per 105 person-years in 2012, but not in Sweden.InterpretationThe incidence of arthroscopies for degenerative knee disease declined after 2008 in both countries. Remarkably, the incidence of arthroscopy for degenerative knee disease and traumatic meniscal tears is 2 to 4 times higher in Finland than in Sweden. Efficient implementation of new high-quality evidence in clinical practice could reduce the number of ineffective surgeries.

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External review and validation of the Swedish national inpatient register

Cited by 4,126 publications

References 58 publications

Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013

Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013

Development and validation of risk prediction model for venous thromboembolism in postpartum women: multinational cohort study

Changes in rates of arthroscopy due to degenerative knee disease and traumatic meniscal tears in Finland and Sweden

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