Validity of distal radius fracture diagnoses in the Swedish National Patient Register

Abstract

Distal radius fractures are one of the most common fractures in adults. More research is needed to establish evidence-based clinical practice guidelines to generate cost-effective and fair fracture treatment. The Swedish National Patient Register is a principal source for population-based epidemiologic studies in Sweden. The validity of some–but not all–diagnoses in the register is high. Little is known regarding the validity of registration of distal radius fractures.A dataset of cases registered with diagnosis of distal radius fracture (S52.5) or distal radius and ulna fracture (S52.6) were collected from the Swedish National Inpatient and Outpatient Registers. Six cohorts, each containing 240 simple random samples, were constructed. Radiographic reports and medical records were reviewed to confirm or reject the diagnosis as well as, in relevant cases, the surgical intervention. Positive predictive values (PPV) were calculated.The PPV for distal radius fracture in the register ranges between 92 and 100%, lower if coded as S52.6 and higher if there was an adherent code of surgical intervention. Codes for surgical intervention reached a PPV of 95–100%.In conclusion, the validity of the codes for diagnosis and the surgical treatment of distal radius fracture is high in the Swedish National Patient Register. According to our results, the register may be used as a reliable data source for population-based research of distal radius fractures.

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“…Limitations of this study, as with any register-based study, are the retrospective design and the risk of misdiagnosis or incorrect entries in the register. However, the SNPR is reported to be of high quality, 21 and any misclassification for the main outcome should not affect the results in any major way. The high quality of the SNPR further strengthens the findings, as the incidence rates were calculated based on the exact number of Swedish males and females in any specific year.…”

“…Data were obtained from the Swedish National Patient Register (SNPR), a Swedish nationwide validated register which contains inpatient data since 1964 and outpatient data since 2001. 21 Reporting data to the NPR is obligatory for all healthcare providers in Sweden, thus ensuring excellent national coverage. The NPR uses the International Classification of Disease (ICD-10) system based on patient-specific identity numbers to categorise patient morbidity and mortality.…”