Abstract
BackgroundHip fractures incur the greatest medical costs of any fracture. Valid epidemiological data are important to monitor for time-dependent changes. In Norway, hip fractures are registered in the Norwegian Patient Registry (NPR), but no published national validation exists. The aim of the present study was a national validation of NPR as a register for hip fractures using diagnostic codes (ICD-10 S 72.0-2) and/or procedure codes (NOMESCO version 1.14 NFBxy (x = 0-9, y = 0-2) or NFJxy (x = 0-9, y = 0-2).MethodA nationwide, population-based cohort comprising a random sub-sample of 1,000 hip fracture-related entries for the years 2008–09 was drawn from the NPR. 200 entries were defined by a combination of diagnostic and procedure codes (subsample 1), 400 entries were defined by diagnostic codes only (subsample 2) and 400 entries were defined by procedure codes only (subsample 3). Accuracy was ascertained through comparison with discharge summaries, procedure notes and X-ray reports requested from 40 health institutions. Comparisons between groups were done by chi2 for categorical and t-test for continuous variables.Results792 health records from 32 institutions were reviewed. High accuracy (98.2%, 95% C.I. 96.5-99.9%) was found for subsample 1, a combination of diagnostic and procedure codes. Coding errors were prominent in other subsamples. Defining fractures by a combination of diagnostic and procedure codes, annual average hip fracture incidence in Norway was 9,092 (95% C.I. 8,934 -9,249), excluding only 6.5% of all hip fractures defined by wider definitions.ConclusionsBased on current coding practice in Norway, a reliable national estimate of hip fracture incidences is found by a combination of relevant ICD-10 and NOMESCO codes in the NPR. This method may be used for monitoring epidemiological changes.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-372) contains supplementary material, which is available to authorized users.
Highlights
Hip fractures incur the greatest medical costs of any fracture
Defining fractures by a combination of diagnostic and procedure codes, annual average hip fracture incidence in Norway was 9,092 (95% C.I. 8,934 -9,249), excluding only 6.5% of all hip fractures defined by wider definitions
Based on current coding practice in Norway, a reliable national estimate of hip fracture incidences is found by a combination of relevant ICD-10 and Nordic Medico- Statistical Committee (NOMESCO) codes in the Norwegian Patient Registry (NPR)
Summary
Hip fractures incur the greatest medical costs of any fracture. Valid epidemiological data are important to monitor for time-dependent changes. In Norway, hip fractures are registered in the Norwegian Patient Registry (NPR), but no published national validation exists. Hip fractures incur the greatest medical costs of any fracture [3,4], valid epidemiological data are important to understand the magnitude of the problem and to monitor changes over time. In Norway, hip fracture registration is done in the Norwegian Patient Registry (NPR) based on both the International Statistical Classification of Diseases and Related Health Problems (ICD) by the World Health Organisation (WHO) [5] and Nordic Medico- Statistical Committee (NOMESCO) version 1.14 procedure codes [6]. Entries in clinical patient databases such as NPR can be used for epidemiological surveillance of disorders such as hip fracture, but due to coding errors validity may vary on a local [7] and national level [8]
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