Data from national health registers as endpoints for the Tromsø Study: Correctness and completeness of stroke diagnoses

Aim: To assess whether stroke diagnoses in national health registers are sufficiently correct and complete to replace manual collection of endpoint data for the Tromsø Study, a population-based epidemiological study. Method: Using the Tromsø Study Cardiovascular Disease Register for 2013–2014 as the gold standard, we calculated correctness (defined as positive predictive value, PPV) and completeness (defined as sensitivity) of stroke cases in four different data subsets derived from the Norwegian Patient Register and the Norwegian Stroke Register. We calculated the sensitivity and PPV with 95% confidence intervals (CIs) assuming a normal approximation of the binomial distribution. Results: In the Norwegian Stroke Register we found a sensitivity of 79.8% (95% CI 74.2–85.4) and a PPV of 97.5% (95% CI 95.1–99.9). In the Norwegian Patient Register the sensitivity was 86.4% (95% CI 81.6–91.1) and the PPV was 84.2% (95% CI 79.2–89.2). The overall highest levels were found in a subset based on a linkage between the Norwegian Stroke Register and the Norwegian Patient Register, with a sensitivity of 88.9% (95% CI 84.5–93.3), and a PPV of 89.3% (95% CI 85.0–93.6). Conclusions: Data from the Norwegian Patient Register and from the linked data set between the Norwegian Patient Register and the Norwegian Stroke Register had acceptable levels of correctness and completeness to be considered as endpoint sources for the Tromsø Study Cardiovascular Disease Register. The benefits of using data from national registers as endpoints in epidemiological studies must be weighed against the impact of potentially decreased data quality

Wake-up stroke and unknown-onset stroke; occurrence and characteristics from the nationwide Norwegian Stroke Register

Introduction: Population-based knowledge of the characteristics of wake-up stroke and unknown-onset stroke is limited. We compared occurrence and characteristics of ischaemic and haemorrhagic wake-up stroke, unknown-onset stroke and known-onset stroke in a nationwide register-based study. Patients and methods: We included patients registered in the Norwegian Stroke Register from 2012 through 2019. Age, sex, risk factors, clinical characteristics, acute stroke treatment and discharge destination were compared according to stroke type and time of onset. Results: Of the 60,320 patients included, 11,451 (19%) had wake-up stroke, 11,098 (18.4%) had unknown time of onset and 37,771 (62.6%) had known symptom onset. The proportion of haemorrhagic stroke was lower among wakeup stroke patients (1107/11,451, 9.7%, 95% CI: 9.1–10.2) than for known-onset stroke (5230/37,771, 13.8%, 95% CI: 13.5–14.2) and for unknown-onset stroke (1850/11,098, 16.7%, 95% CI: 16.0–17.4). Mild stroke (NIHSS Discussion and conclusions: Ischaemic wake-up strokes shared baseline characteristics with known-onset strokes, but tended to be milder. Ischaemic unknown-onset stroke patients differed significantly from wake-up stroke, emphasising the importance of considering them as separate entities

Aktivitetsdata for somatiske sykehus driftsåret 2004

STF78 A055502 Den samlede veksten i aktiviteten ved de somatiske sykehusene fra 2003 til 2004 var på 4,3 prosent. I 2004 er det i alt 11 nye private institusjoner som leverer pasientdata til Norsk pasientregister sammenlignet med 2003. Holder man disse oppholdene ved de nye private institusjonene utenfor sammenligningen, vil den totale økningen i antall opphold fra 2003 til 2004 være på 3,6 %. Den sterkeste aktivitetsveksten er innenfor dagopphold innlagte (dialyse og rehabilitering) som øker med 11,1 %, noe som utgjør 42 prosent av den samlede aktivitetsveksten. Poliklinisk dagbehandling (dagkirurgi og cytostaticabehandling) øker med 8,6 %, mens økningen i heldøgnsoppholdet er på 1,6 % i samme periode. Dette utgjør henholdsvis 34 prosent og 24 prosent av aktivitetsveksten fra 2003 til 2004. Ser man på dagopphold innlagte og dagbehandling poliklinikk samlet, øker denne aktiviteten med 9,8 prosent fra 2003 til 2004, noe som utgjør 76 prosent av den totale aktivitetsveksten. I tillegg øker antallet polikliniske konsultasjoner totalt med nesten 134 000 konsultasjoner fra 2003 til 2004, noe som tilsvarer en aktivitetsvekst på 4,1 %. Dersom vi ser på den samlede aktivitetsveksten inklusive fødestuer fordelt per helseregion, ser vi at institusjonene i Helse Vest RHF har størst prosentvis aktivitetsøkning av d efem RHF-ene i perioden med 6,0 %, mens Helse Nord RHG har minst økning med 1,3 % (tabell 3). Aktivitetsveksten i Helse Øst RHF utgjør den største andelen av aktivitetsveksten med 32 prosent, mens veksten i Helse Nord RHF utgjør minst med 3 prosent

Hjerneslag i Norge 2015-16 - behandling og resultater

BAKGRUNN I Norge er hjerneslagbehandlingen desentralisert, og pasienter med hjerneslag blir behandlet ved 50 sykehus. Vi har kartlagt slagbehandlingen ved sykehusene og sammenstilt dette med data fra Norsk hjerneslagregister (NHR). Vi ville undersøke om det var variasjon i behandlingstiltak og behandlingsresultater mellom universitetssykehus og lokalsykehus. MATERIALE OG METODE I en spørreundersøkelse blant alle norske sykehus ble behandlingstiltak og ressurstilgjengelighet kartlagt. Data fra hjerneslagregisteret i 2015–16 (N = 17 183) ble benyttet for å sammenligne pasientkarakteristika og behandlingsresultater for pasienter ved universitetssykehus (n = 5 312) og lokalsykehus (n = 11 871). Behandlingskvalitet ble målt med hjelp av kvalitetsindikatorene i hjerneslagregisteret. RESULTATER Ved universitetssykehusene var median alder 75 år (interkvartilbredde 65–83), og 44,1 % av pasientene var kvinner. Ved lokalsykehusene var median alder 76 år (interkvartilbredde 67–85), og 46,7 % var kvinner. Måloppnåelsen på fem av ti kvalitetsindikatorer var høy, blant annet ble over 90 % av pasientene behandlet i slagenhet uavhengig av sykehustype. Ved universitetssykehusene fikk 1 038 (19,0 %) pasienter trombolytisk behandling, mot 1 612 (17,2 %) ved lokalsykehusene. Justert for alder og bevissthetsgrad var sannsynligheten for å være selvhjulpen tre måneder etter hjerneslaget høyere ved lokalsykehus (OR 1,15, KI 1,04–1,27). FORTOLKNING Den desentraliserte hjerneslagbehandlingen i Norge oppnår høy og moderat måloppnåelse på kvalitetsindikatorene i Norsk hjerneslagregister. Lokalsykehus synes å ha like god eller bedre behandlingskvalitet sammenlignet med universitetssykehus

Thrombolytic Treatment in Wake‐Up Stroke: A Propensity Score–Matched Analysis of Treatment Effectiveness in the Norwegian Stroke Registry

Background Previous clinical trials found improved outcome of thrombolytic treatment in patients with ischemic wake‐up stroke (WUS) selected by advanced imaging techniques. The authors assessed the effectiveness of thrombolytic treatment in patients with WUS in a nationwide stroke registry. Methods and Results Using propensity score matching, the authors assessed the effectiveness and safety of thrombolytic treatment versus no thrombolytic treatment in 726 patients (363 matched pairs) with WUS in the Norwegian Stroke Registry in 2014 to 2019. Thrombolytic treatment in WUS versus known‐onset stroke was compared in 730 patients (365 matched pairs). Functional outcomes were assessed by the modified Rankin Scale (mRS) at 3 months. A significant benefit of thrombolytic treatment in WUS was seen in ordinal analysis (odds ratio [OR], 1.48 [95% CI, 1.15–1.91]; P=0.003) and for mRS 0 to 2 (OR, 1.81 [95% CI, 1.29–2.52]; P=0.001) but not for mRS 0 or 1 (OR, 1.32 [95% CI, 1.00–1.74]; P=0.050). The proportion of patients with mRS 0 or 1 was lower in patients with WUS who underwent thrombolysis versus those with known‐onset stroke (50.4% versus 59.5%; OR, 0.69 [95% CI, 0.52–0.93]; P=0.013), while outcomes were similar between groups for mRS 0 to 2 and ordinal analysis. Symptomatic intracranial hemorrhage after thrombolytic treatment occurred in 4.4% of patients with WUS and 3.9% of patients with known‐onset stroke (OR, 1.14 [95% CI, 0.54–2.41]; P=0.726). Conclusions Thrombolytic treatment in patients with WUS was associated with improved functional outcome compared with patients with no thrombolytic treatment and was not associated with increased rates of symptomatic intracranial hemorrhage compared with known‐onset stroke. The results indicate that thrombolytic treatment is effective and safe in WUS in a real‐life setting

MOESM1 of Inter-rater reliability of a national acute stroke register

Additional file 1. Contingency tables of all variables

Validating Acute Myocardial Infarction Diagnoses in National Health Registers for Use as Endpoint in Research: The Tromsø Study

Purpose: To assess whether acute myocardial infarction (MI) diagnoses in national health registers are sufficiently correct and complete to replace manual collection of endpoint data for a population-based, epidemiological study. Patients and Methods: Using the Tromsø Study Cardiovascular Disease Register for 2013– 2014 as gold standard, we calculated correctness (defined as positive predictive value (PPV)) and completeness (defined as sensitivity) of MI cases in the Norwegian Myocardial Infarction Register and the Norwegian Patient Register separately and in combination. We calculated the sensitivity and PPV with 95% confidence intervals using the Clopper-Pearson Exact test. Results: We identified 153 MI cases in the gold standard. In the Norwegian Myocardial Infarction Register, we found a PPV of 97.1% (95% confidence interval (CI) 92.8– 99.2) and a sensitivity of 88.2% (95% CI 82.0– 92.9). In the Norwegian Patient Register, the PPV was 96.3% (95% CI 91.6– 98.8) and the sensitivity was 85.6% (95% CI 79.0– 90.8). The combined dataset of the Norwegian Myocardial Infarction Register and the Norwegian Patient Register had a PPV of 96.6% (95% CI 92.1– 98.9) and a sensitivity of 91.5% (95% CI 85.9– 95.4). Conclusion: MI diagnoses in both the Norwegian Myocardial Infarction Register and the Norwegian Patient Register were highly correct and complete, and each of the registers could be considered as endpoint sources for the Tromsø Study. A combination of the two national registers seemed, however, to represent the most comprehensive data source overall. The benefits of using data from national registers as endpoints in epidemiological studies include faster, less resource-intensive access to nationwide data and considerably lower loss to follow-up, compared to manual data collection in a limited geographical area