Validation of an Operational Definition to Identify Distal Radius Fractures in a National Health Insurance Database

Lee, Yong Seuk; Park, Chanmi; Won, Seokhyung; Park, Jung-Wee; Koo, Kyung Hoi; Ha, Yong Chan; Jung, Hyoung‐Seok

doi:10.1016/j.jhsa.2021.03.001

Cited by 8 publications

(9 citation statements)

References 31 publications

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“… 22 23 24 Validation studies are the best method to confirm the proposed algorithm of diagnostic codes. 24 According to our recent study, the sensitivity was 62.5% and the positive predictive value of operational definition was 59.7%, which was lower than that of hip 35 or wrist fractures, 36 but higher than that of other VFs. 37 To diagnose VFs as accurately as possible, we used a one-year lag time period after being diagnosed as underweight and excluded patients with previous VFs.…”

Section: Discussionmentioning

confidence: 80%

The Impact of Persistent Low Weight Status on the Occurrence of Vertebral Fractures: A Nationwide Population-Based Cohort Study

Park

Han

et al. 2023

J Korean Med Sci

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Background Although, being underweight is commonly associated with osteoporosis and sarcopenia, its association with vertebral fractures (VFs), is less well researched. We investigated the influence of cumulative, chronic periods of low weight and changes in body weight on VF development. Methods We used a nationwide, population-based database with data on people (> 40 years) who attended three health screenings between January 1, 2007, and December 31, 2009 to assess the incidence of new VFs. Cox proportional hazard analyses were used to establish the hazard ratios (HRs) for new VFs based on the degree of body mass index (BMI), the cumulative numbers of underweight participants, and temporal change in weight. Results Of the 561,779 individuals in this analysis, 5,354 (1.0%) people were diagnosed three times, 3,672 (0.7%) were diagnosed twice, and 6,929 (1.2%) were diagnosed once. The fully adjusted HR for VFs in underweight individuals was 1.213. Underweight individuals diagnosed only once, twice, or three times had an adjusted HR of 0.904, 1.443, and 1.256, respectively. Although the adjusted HR was higher in adults who were consistently underweight, there was no difference in those who experienced a temporal change in body weight. BMI, age, sex, and household income were significantly associated with VF incidence. Conclusion Low weight is a risk factor for VFs in the general population. Given the significant correlation between cumulative periods of low weight and the risk of VFs, it is necessary to treat underweight patients before a VF to prevent its development and other osteoporotic fractures.

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Section: Discussionmentioning

confidence: 80%

The Impact of Persistent Low Weight Status on the Occurrence of Vertebral Fractures: A Nationwide Population-Based Cohort Study

Park

Han

et al. 2023

J Korean Med Sci

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“…Secondary, or subordinated, diagnostic codes imply the use of fewer medical resources than those needed for primary diagnoses. For this reason, the order of diagnostic codes is often used as a criterion for developing operational definitions using claims data, 39 40 and classifying the codes as primary or secondary. Additionally, imaging and procedure codes were used along with diagnostic codes to increase the accuracy of the operational definitions.…”

Section: Discussionmentioning

confidence: 99%

“…To date, various operational definitions have been proposed for the identification of patients with osteoporotic fractures including VF, hip fracture and distal radius fracture. 35 40 41 Unlike other osteoporotic fractures, 40 41 identification of patients with osteoporosis-related VFs in claims data is challenging because the claims database does not include data on injury mechanism or bone mineral density. Moreover, the patient’s condition often improves with simple conservative treatments, such as prescription pain relievers, precluding the need for specialty treatments such as vertebroplasty or fusion surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Third, the PPV of our operational definition for VF was lower than those reported for hip fracture (59.1–77.4%) 41 and wrist fracture (95.6–98.2%). 40 Most patients with VF are treated conservatively and visit the outpatient clinic several times during the treatment course; this unique clinical feature may account for this difference.…”

Section: Discussionmentioning

confidence: 99%

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Operational Definition Identifying Osteoporotic Vertebral Fractures in the Claims Database

Hong

Lee

et al. 2022

J Korean Med Sci

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Background We analyzed the International Classification of Diseases, 10th edition (ICD-10) diagnostic codes, procedure codes, and radiographic image codes for vertebral fracture (VF) used in the database of Health Insurance Review and Assessment Service (HIRA) of Korea to establish a validated operational definition for identifying patients with osteoporotic VF in claims data. Methods We developed three operational definitions for detecting VFs using 9 diagnostic codes, 5 procedure codes and 4 imaging codes. Medical records and radiographs of 2,819 patients, who had primary and subordinated codes of VF between January 2016 and December 2016 at two institutions, were reviewed to detect true vertebral fractures. We evaluated the sensitivity and positive predictive value (PPV) of the operational definition in detecting true osteoporotic VF and obtained the receiver operating characteristic (ROC) curve. Results Among the 2,819 patients who had primary or secondary diagnosis codes for VF, 995 patients satisfied at least one of the criteria for the operational definition of osteoporotic VF. Of these patients, 594 were judged as having true fractures based on medical records and radiographic examinations. The sensitivity and PPV were 62.5 (95% confidence interval [CI], 59.4–65.6) and 59.7(95% CI, 56.6–62.8) respectively. In the receiver operating characteristic analysis, area under the curve (AUC) was 0.706 (95% CI, 0.688–0.724). Conclusion Our findings demonstrate the validity of our operational definitions to identify VFs more accurately using claims data. This algorithm to identify VF is likely to be useful in future studies for diagnosing osteoporotic VF.

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“…to verify the validity of the hip fracture diagnoses. Nevertheless, in the latest study that evaluated the validity of the operational definition for distal radius fractures using the Korean National Health Insurance data, the sensitivity, specificity, and positive predictive value of the definition with all diagnosis codes were similar to those of the definition with primary and secondary codes [ 49 ]. Specifically, compared with the definition without procedure codes, the operational definition with all diagnosis and procedure codes showed lower sensitivity, higher specificity, and higher PPV.…”

Section: Discussionmentioning

confidence: 99%

Validation of Operational Definition to Identify Patients with Osteoporotic Hip Fractures in Administrative Claims Data

et al. 2022

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As incidences of osteoporotic hip fractures (OHFs) have increased, identifying OHFs has become important to establishing the medical guidelines for their management. This study was conducted to develop an operational definition to identify patients with OHFs using two diagnosis codes and eight procedure codes from health insurance claims data and to assess the operational definition’s validity through a chart review. The study extracted data on OHFs from 522 patients who underwent hip surgeries based on diagnosis codes. Orthopedic surgeons then reviewed these patients’ medical records and radiographs to identify those with true OHFs. The validities of nine different algorithms of operational definitions, developed using a combination of three levels of diagnosis codes and eight procedure codes, were assessed using various statistics. The developed operational definition showed an accuracy above 0.97 and an area under the receiver operating characteristic curve above 0.97, indicating excellent discriminative power. This study demonstrated that the operational definition that combines diagnosis and procedure codes shows a high validity in detecting OHFs and can be used as a valid tool to detect OHFs from big health claims data.

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Validation of an Operational Definition to Identify Distal Radius Fractures in a National Health Insurance Database

Cited by 8 publications

References 31 publications

The Impact of Persistent Low Weight Status on the Occurrence of Vertebral Fractures: A Nationwide Population-Based Cohort Study

The Impact of Persistent Low Weight Status on the Occurrence of Vertebral Fractures: A Nationwide Population-Based Cohort Study

Operational Definition Identifying Osteoporotic Vertebral Fractures in the Claims Database

Validation of Operational Definition to Identify Patients with Osteoporotic Hip Fractures in Administrative Claims Data

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