Splenomegaly - Diagnostic validity, work-up, and underlying causes.

Emelie Curovic Rotbain,Allan Meldgaard Lund,Dennis Lund Hansen,Ove Schaffalitzky De Muckadell,Flemming Wibrand,Henrik Frederiksen,Francesco Bertolini

doi:10.1371/journal.pone.0186674

Emelie Curovic Rotbain, Allan Meldgaard Lund + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0186674

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Abstract

PurposeOur aim was to assess the validity of the ICD-10 code for splenomegaly in the Danish National Registry of Patients (DNRP), as well as to investigate which underlying diseases explained the observed splenomegaly.BackgroundSplenomegaly is a common finding in patients referred to an internal medical department and can be caused by a large spectrum of diseases, including haematological diseases and liver cirrhosis. However, some patients remain without a causal diagnosis, despite extensive medical work-up.Patients and methodsWe identified 129 patients through the DNRP, that had been given the ICD-10 splenomegaly diagnosis code in 1994–2013 at Odense University Hospital, Denmark, excluding patients with prior splenomegaly, malignant haematological neoplasia or liver cirrhosis. Medical records were reviewed for validity of the splenomegaly diagnosis, diagnostic work-up, and the underlying disease was determined. The positive predictive value (PPV) with 95% confidence interval (CI) was calculated for the splenomegaly diagnosis code. Patients with idiopathic splenomegaly in on-going follow-up were also invited to be investigated for Gaucher disease.ResultsThe overall PPV was 92% (95% CI: 85, 96). Haematological diseases were the underlying causal diagnosis in 39%; hepatic diseases in 18%, infectious disease in 10% and other diseases in 8%. 25% of patients with splenomegaly remained without a causal diagnosis. Lymphoma was the most common haematological causal diagnosis and liver cirrhosis the most common hepatic causal diagnosis. None of the investigated patients with idiopathic splenomegaly had Gaucher disease.ConclusionOur findings show that the splenomegaly diagnosis in the DNRP is valid and can be used in registry-based studies. However, because of suspected significant under-coding, it should be considered if supplementary data sources should be used in addition, in order to attain a more representative population. Haematological diseases were the most common cause, however in a large fraction of patients no causal diagnosis was found.

Highlights

IntroductionIs a common finding in patients referred to an internal medical departments and has been reported in 0.3% of all hospital admissions [1, 2] and amongst 2.9% of college freshmen [3] in North American populations
Is a common finding in patients referred to an internal medical department and can be caused by a large spectrum of diseases, including haematological diseases and liver cirrhosis
Haematological diseases were the underlying causal diagnosis in 39%; hepatic diseases in 18%, infectious disease in 10% and other diseases in 8%. 25% of patients with splenomegaly remained without a causal diagnosis

Summary

Introduction

Is a common finding in patients referred to an internal medical departments and has been reported in 0.3% of all hospital admissions [1, 2] and amongst 2.9% of college freshmen [3] in North American populations. To the best of our knowledge, there is no published data on the risk of a subsequent diagnosis of haematological diseases, hepatic diseases or storage diseases, for patients already diagnosed with splenomegaly. Such data would help physicians in the diagnostic process of patients with splenomegaly, in idiopathic cases when contemplating diagnostic splenectomy. Is a common finding in patients referred to an internal medical department and can be caused by a large spectrum of diseases, including haematological diseases and liver cirrhosis. Some patients remain without a causal diagnosis, despite extensive medical work-up

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