Reliability of Past Medical History in a Single Hospital Participating in Get With The Guidelines-Stroke Registry.
Reliability of Past Medical History in a Single Hospital Participating in Get With The Guidelines-Stroke Registry.
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DOI：
10.1161/jaha.122.025308
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发表时间：
2022-07-05
影响因子：
5.4
通讯作者：
Kasner, Scott E.
中科院分区：
文献类型：
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作者：
Favilla, Christopher G.;Ford, Alice F.;Khazaal, Ossama;Cristancho, Daniel;Grodinsky, Emily;Dawod, Judy;Kasner, Scott E.
GWTG（Get With The Guidelines）-卒中登记支持临床研究和质量改进项目，这些项目通常依赖于过去的病史元素，其可靠性在很大程度上仍然未知。在这里，我们评估了当地GWTG-卒中数据集中特定既往病史元素的可靠性，特别注意计算CHA 2DS 2-VASc评分。通过查询宾夕法尼亚大学医院的GWTG IQVIA登记平台，确定了一个单中心队列，该队列针对2017年1月至2020年12月期间因急性缺血性卒中入院且既往有房颤病史的患者。从登记研究中检索人口统计学和既往已知病史元素，以计算CHA 2DS 2 ‐VASc评分。五名神经科医生从健康记录中提取了相同的病史元素。κ统计量量化了病史元素和CHA 2DS 2 ‐VASc评分的可靠性。该队列纳入了453例急性缺血性卒中和既往已知房颤患者。与手动再提取相比，基于登记的病史要素仅具有中等可靠性：充血性心力衰竭（κ=0.53）、高血压（κ=0.42）、糖尿病（κ=0.80）、既往卒中（κ=0.45）和血管疾病（κ=0.48）。然而，利用这些变量计算CHA 2DS 2 ‐VASc评分更可靠（κ=0.73）。在这项单中心研究中，GWTG卒中登记研究中先前已知的病史要素仅具有适度的可靠性，这表明在基于登记研究的研究中依赖任何个体病史要素时应谨慎。结合这些变量计算CHA 2DS 2 ‐VASc评分更可靠。在假设普遍性之前，需要多中心数据。
The GWTG (Get With The Guidelines)‐Stroke registry supports clinical research and quality improvement projects that often rely on past medical history elements, the reliability of which remains largely unknown. Here, we evaluated the reliability of specific past medical history elements in a local GWTG–Stroke data set, with particular attention to calculating the CHA2DS2‐VASc score. A single‐center cohort was identified by querying the Hospital of the University of Pennsylvania’s GWTG IQVIA Registry Platform for patients admitted with acute ischemic stroke between January 2017 and December 2020, with a previously known history of atrial fibrillation. Demographics and previously known medical history elements were retrieved from the registry to calculate the CHA2DS2‐VASc score. Five neurologists abstracted the same medical history elements from the health records. The κ statistics quantified the reliability of medical history elements and CHA2DS2‐VASc score. Four hundred fifty‐three patients with acute ischemic stroke and previously known atrial fibrillation were included in the cohort. In comparison with manual reabstraction, registry‐based medical history elements were only moderately reliable: congestive heart failure (κ=0.53), hypertension (κ=0.42), diabetes (κ=0.80), prior stroke (κ=0.45), and vascular disease (κ=0.48). However, leveraging these variables to calculate the CHA2DS2‐VASc score was more reliable (κ=0.73). Previously known medical history elements in the GWTG‐Stroke registry were only modestly reliable in this single‐center study, suggesting caution should be exercised when relying on any individual history elements in registry‐based research. Combining these variables to calculate the CHA2DS2‐VASc score was somewhat more reliable. Multicenter data are needed before assuming generalizability.