On the need of validating inpatient registers

Abstract

Study design: Register study. Objectives: To design and implement a validation process to check the completeness of the Hospital Discharge Register (HDR) held by the Swedish National Board of Health and Welfare. Setting: Sweden. Methods: An accurate traumatic spinal cord injury prevalence group (n ¼ 495) was acquired from the Swedish Spinalis Clinic. A register control was performed on the group by raising three questions to check the validity of the HDR: Is an inpatient stay registered in association with the injury date? Is the reported first length of stay plausible, given the level and extent of injury? Are all the anticipated care and/or rehabilitation providers represented in the HDR? Results: For 62% (of 413 cases) the first registered hospitalization date correlated with the injury date. For the other 38%, hospitalization was reported to start between 2 and 8651 days after injury. Considering the level and extent of injury, individuals were reported to have unrealistically short initial hospitalization. The prevalence group visited 42 different hospitals and 47 clinics. Five rehabilitation clinics, though, were not reported. Conclusions: The HDR is a valuable source when conducting epidemiological and health services research. However, using the register without any validation process could, as detected in the investigated diagnosis group, lead to a severe underestimation of the inpatient usage. The study showed that systematic errors could be detected by means of extensive knowledge of the diagnosis group.

External review and validation of the Swedish national inpatient register

“…For instance, Nordgren found that for 62% (257/413) of spinal cord injuries, the hospital admission date agreed with the injury date (≤2 days within the injury date [17]).…”

Incidence of Traumatic Peripheral Nerve Injuries and Amputations in Sweden between 1998 and 2006

“…Although reliability of the register is considered to be high, shortcomings have also been reported. Validation of Swedish HDR data on traumatic spinal cord injuries revealed an underestimation of inpatient usage compared to a register on traumatic spinal cord injuries known to be accurate [35] . The National Board for Health and Welfare also regularly evaluates the quality of this register, both through studying the occurrence of reported hospital discharges that lack all or part of the requested information, and validation through comparison of reports of a number of randomly selected hospital discharges and their corresponding medical records.…”