scholarly journals Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register

2019 ◽  
Author(s):  
Anders Forss ◽  
Pär Myrelid ◽  
Ola Olén ◽  
Åsa H Everhov ◽  
Caroline Nordenvall ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Sensitivity And Specificity ◽  
Bowel Disease ◽  
Surgical Procedure ◽  
High Sensitivity ◽  
National Patient Register ◽  
Patient Register ◽  
National Patient ◽  
Inflammatory Bowel ◽  
Procedure Codes

Abstract Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register Background: About 50% of patients with Crohn’s disease (CD) and about 20% of those with ulcerative colitis (UC) undergo surgery at some point during the course of the disease. The diagnostic validity of the Swedish National Patient Register (NPR) has previously been shown to be high for inflammatory bowel disease (IBD), but there are little data on the validity of IBD-related surgical procedure codes. Methods: Using patient chart data as the gold standard, surgical procedure codes registered between 1966 and 2014 in the NPR were abstracted and validated in 262 patients with a medical diagnosis of IBD. Of these, 53 patients had reliable data about IBD-related surgery. The positive predictive value (PPV), sensitivity and specificity of the surgical procedure codes were calculated. Results: In total, 158 codes were registered in the NPR. 155 of these, representing 60 different surgical procedure codes, were also present in the patient charts and validated using a standardized form. Of the validated codes 153/155 were concordant against the patient charts, corresponding to a PPV of 96.8% (95%CI=93.9-99.1). Stratified in abdominal, perianal and other surgery, the corresponding PPVs were 94.1% (95%CI=88.7-98.6), 100% (95%CI=100-100) and 98.1% (95%CI=93.1-100), respectively. Of 164 surgical procedure codes in the validated patient charts, 155 were registered in the NPR, corresponding to a sensitivity of the surgical procedure codes of 94.5% (95%CI=89.6-99.3). The specificity of the NPR was 98.5% (95%CI=97.6-100). Conclusions: Data on IBD-related surgical procedure codes are reliable, with the Swedish National Patient Register showing a high sensitivity and specificity for such surgery. Keywords: Epidemiology, Inflammatory bowel disease, Validation, National Patient Register, Procedure code

scholarly journals Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Anders Forss ◽  
Pär Myrelid ◽  
Ola Olén ◽  
Åsa H. Everhov ◽  
Caroline Nordenvall ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Sensitivity And Specificity ◽  
Bowel Disease ◽  
Surgical Procedure ◽  
High Sensitivity ◽  
National Patient Register ◽  
Patient Register ◽  
National Patient ◽  
Inflammatory Bowel ◽  
Procedure Codes

Abstract Background About 50% of patients with Crohn’s disease (CD) and about 20% of those with ulcerative colitis (UC) undergo surgery at some point during the course of the disease. The diagnostic validity of the Swedish National Patient Register (NPR) has previously been shown to be high for inflammatory bowel disease (IBD), but there are little data on the validity of IBD-related surgical procedure codes. Methods Using patient chart data as the gold standard, surgical procedure codes registered between 1966 and 2014 in the NPR were abstracted and validated in 262 randomly selected patients with a medical diagnosis of IBD. Of these, 53 patients had reliable data about IBD-related surgery. The positive predictive value (PPV), sensitivity and specificity of the surgical procedure codes were calculated. Results In total, 158 surgical procedure codes were registered in the NPR. One hundred fifty-five of these, representing 60 different procedure codes, were also present in the patient charts and validated using a standardized form. Of the validated codes 153/155 were concordant with the patient charts, corresponding to a PPV of 96.8% (95%CI = 93.9–99.1). Stratified in abdominal, perianal and other surgery, the corresponding PPVs were 94.1% (95%CI = 88.7–98.6), 100% (95%CI = 100–100) and 98.1% (95%CI = 93.1–100), respectively. Of 164 surgical procedure codes in the validated patient charts, 155 were registered in the NPR, corresponding to a sensitivity of the surgical procedure codes of 94.5% (95%CI = 89.6–99.3). The specificity of the NPR was 98.5% (95%CI = 97.6–100). Conclusions Data on IBD-related surgical procedure codes are reliable, with the Swedish National Patient Register showing a high sensitivity and specificity for such surgery.

scholarly journals Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register

2019 ◽  
Author(s):  
Anders Forss ◽  
Pär Myrelid ◽  
Ola Olén ◽  
Åsa H Everhov ◽  
Caroline Nordenvall ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Sensitivity And Specificity ◽  
Bowel Disease ◽  
Surgical Procedure ◽  
High Sensitivity ◽  
National Patient Register ◽  
Patient Register ◽  
National Patient ◽  
Inflammatory Bowel ◽  
Procedure Codes

Abstract Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register Background: About 50% of patients with Crohn’s disease (CD) and about 20% of those with ulcerative colitis (UC) undergo surgery at some point during the course of the disease. The diagnostic validity of the Swedish National Patient Register (NPR) has previously been shown to be high for inflammatory bowel disease (IBD), but there are little data on the validity of IBD-related surgical procedure codes. Methods: Using patient chart data as the gold standard, surgical procedure codes registered between 1966 and 2014 in the NPR were abstracted and validated in 262 patients with a medical diagnosis of IBD. Of these, 53 patients had reliable data about IBD-related surgery. The positive predictive value (PPV), sensitivity and specificity of the surgical procedure codes were calculated. Results: In total, 158 codes were registered in the NPR. 155 of these, representing 60 different surgical procedure codes, were also present in the patient charts and validated using a standardized form. Of the validated codes 153/155 were concordant against the patient charts, corresponding to a PPV of 96.8% (95%CI=93.9-99.1). Stratified in abdominal, perianal and other surgery, the corresponding PPVs were 94.1% (95%CI=88.7-98.6), 100% (95%CI=100-100) and 98.1% (95%CI=93.1-100), respectively. Of 164 surgical procedure codes in the validated patient charts, 155 were registered in the NPR, corresponding to a sensitivity of the surgical procedure codes of 94.5% (95%CI=89.6-99.3). The specificity of the NPR was 98.5% (95%CI=97.6-100). Conclusions: Data on IBD-related surgical procedure codes are reliable, with the Swedish National Patient Register showing a high sensitivity and specificity for such surgery. Keywords: Epidemiology, Inflammatory bowel disease, Validation, National Patient Register, Procedure code

scholarly journals Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register

2019 ◽  
Author(s):  
Anders Forss ◽  
Pär Myrelid ◽  
Ola Olén ◽  
Åsa H Everhov ◽  
Caroline Nordenvall ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Sensitivity And Specificity ◽  
Bowel Disease ◽  
Surgical Procedure ◽  
High Sensitivity ◽  
National Patient Register ◽  
Patient Register ◽  
National Patient ◽  
Inflammatory Bowel ◽  
Procedure Codes

Abstract Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register Background: About 50% of patients with Crohn’s disease (CD) and about 20% of those with ulcerative colitis (UC) undergo surgery at some point during the course of the disease. The diagnostic validity of the Swedish National Patient Register (NPR) has previously been shown to be high for inflammatory bowel disease (IBD), but there are little data on the validity of IBD-related surgical procedure codes. Methods: Using patient chart data as the gold standard, surgical procedure codes registered between 1966 and 2014 in the NPR were abstracted and validated in 262 patients with a medical diagnosis of IBD. Of these, 53 patients had reliable data about IBD-related surgery. The positive predictive value (PPV), sensitivity and specificity of the surgical procedure codes were calculated. Results: In total, 158 codes were registered in the NPR. 155 of these, representing 60 different surgical procedure codes, were also present in the patient charts and validated using a standardized form. Of the validated codes 153/155 were concordant against the patient charts, corresponding to a PPV of 96.8% (95%CI=93.9-99.1). Stratified in abdominal, perianal and other surgery, the corresponding PPVs were 94.1% (95%CI=88.7-98.6), 100% (95%CI=100-100) and 98.1% (95%CI=93.1-100), respectively. Of 164 surgical procedure codes in the validated patient charts, 155 were registered in the NPR, corresponding to a sensitivity of the surgical procedure codes of 94.5% (95%CI=89.6-99.3). The specificity of the NPR was 98.5% (95%CI=97.6-100). Conclusions: Data on IBD-related surgical procedure codes are reliable, with the Swedish National Patient Register showing a high sensitivity and specificity for such surgery. Keywords: Epidemiology, Inflammatory bowel disease, Validation, National Patient Register, Procedure code

scholarly journals Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register

2019 ◽  
Author(s):  
Anders Forss ◽  
Pär Myrelid ◽  
Ola Olén ◽  
Åsa H Everhov ◽  
Caroline Nordenvall ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Sensitivity And Specificity ◽  
Bowel Disease ◽  
Surgical Procedure ◽  
High Sensitivity ◽  
National Patient Register ◽  
Patient Register ◽  
National Patient ◽  
Inflammatory Bowel ◽  
Procedure Codes

Abstract Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register Background: About 50% of patients with Crohn’s disease (CD) and about 20% of those with ulcerative colitis (UC) undergo surgery at some point during the course of the disease. The diagnostic validity of the Swedish National Patient Register (NPR) has previously been shown to be high for inflammatory bowel disease (IBD), but there are little data on the validity of IBD-related surgical procedure codes. Methods: Using patient chart data as the gold standard, surgical procedure codes registered between 1966 and 2014 in the NPR were abstracted and validated in 262 patients with a medical diagnosis of IBD. Of these, 53 patients had reliable data about IBD-related surgery. The positive predictive value (PPV), sensitivity and specificity of the surgical procedure codes were calculated. Results: In total, 158 codes were registered in the NPR. 155 of these, representing 60 different surgical procedure codes, were also present in the patient charts and validated using a standardized form. Of the validated codes 153/155 were concordant against the patient charts, corresponding to a PPV of 96.8% (95%CI=93.9-99.1). Stratified in abdominal, perianal and other surgery, the corresponding PPVs were 94.1% (95%CI=88.7-98.6), 100% (95%CI=100-100) and 98.1% (95%CI=93.1-100), respectively. Of 164 surgical procedure codes in the validated patient charts, 155 were registered in the NPR, corresponding to a sensitivity of the surgical procedure codes of 94.5% (95%CI=89.6-99.3). The specificity of the NPR was 98.5% (95%CI=97.6-100). Conclusions: Data on IBD-related surgical procedure codes are reliable, with the Swedish National Patient Register showing a high sensitivity and specificity for such surgery. Keywords: Epidemiology, Inflammatory bowel disease, Validation, National Patient Register, Procedure code

Neutrophil to Lymphocyte Ratio in Diagnosis of Inflammatory Bowel Disease and Correlation with Disease Severity Assessed by Ultrasound and Colonoscopy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Wesam A Ebrahem ◽  
Shereen A Saleh ◽  
Mohamed O Aly ◽  
Dina S Mohamed
Keyword(s):  
Inflammatory Bowel Disease ◽  
Sensitivity And Specificity ◽  
Bowel Disease ◽  
Complete Blood Count ◽  
High Sensitivity ◽  
Endoscopic Examination ◽  
Control Group ◽  
Moderate Activity ◽  
Lymphocyte Ratio ◽  
Inflammatory Bowel

Abstract Background Inflammatory bowel disease (IBD) is a chronic idiopathic disease affecting author the gastrointestinal tract that is comprised of two separate, but related intestinal disorders; Crohn’ s disease (CD) and ulcerative colitis (UC). The diagnosis of IBD is most commonly made on the basis of clinical features in combination with findings on ultrasonography, endoscopy and histopathology. Patients and Methods This is a crosssectional prospective observational study. This study included 40 IBD patients (19 females and 21 males), presented to Internal Medicine department, El-Demerdash Hospital, Ain Shams University from June 2018 to June 2019. Patients were matched with 10 healthy subjects (7 females and 3 males) as a control group. All patients subjected to the following: Thorough medical history, clinical examination (general and local) and laboratory investigations including complete blood count with calculation of neutrophils to lymphocyte ratio, ESR and CRP on the day of the colonoscopic procedure. US examination and endoscopic examination were done for every patient. Results Mean value of NLR in IBD patients was significantly higher than those in control group representing 3.12±1.87 and 1.88±0.42 respectively but it was statisitically insignificant between active and inactive IBD patients with best cut off >2,01 to differentiate active from inactive patient.THE NLR value was correllating with CRP only with no correlation with ESR,NLR value also has association with US findings that suggesting activity with best cut off >2.5 to detect these findings by US in active patients.US has high sensitivity and specificity in discriminating patients with moderate and severe activity from those with mild activity or those in remission but it was unable to discriminate patient of moderate activity from patients with severe activity with strong assossiation with endoscopic scores of activity. Conclusion NLR values had higher sensitivity and specificity than CRP and ESR with the benefit of being readily available with an affordable price. They are more useful when utilized together with serum laboratory inflammatory indices (CRP and ESR).

scholarly journals Optimal Range of Fecal Calprotectin for Predicting Mucosal Healing in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-11
Author(s):  
Bing-Jie Xiang ◽  
Min Jiang ◽  
Ming-Jun Sun ◽  
Cong Dai
Keyword(s):  
Inflammatory Bowel Disease ◽  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Sensitivity And Specificity ◽  
Bowel Disease ◽  
Meta Analysis ◽  
Positive Likelihood Ratio ◽  
Fecal Calprotectin ◽  
Mucosal Healing ◽  
Inflammatory Bowel

<b><i>Objective:</i></b> Fecal calprotectin (FC) is a promising marker for assessment of inflammatory bowel disease (IBD) activity. However, the utility of FC for predicting mucosal healing (MH) of IBD patients has yet to be clearly demonstrated. The objective of our study was to perform a meta-analysis evaluating the diagnostic accuracy of FC in predicting MH of IBD patients. <b><i>Methods:</i></b> We systematically searched the databases for studies from inception to April 2020 that evaluated MH in IBD. The methodological quality of each study was assessed according to the Quality Assessment of Diagnostic Accuracy Studies checklist. The extracted data were pooled using a summary receiver operating characteristic curve model. Random-effects model was used to summarize the diagnostic odds ratio, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. <b><i>Results:</i></b> Sixteen studies comprising 1,682 ulcerative colitis (UC) patients and 4 studies comprising 221 Crohn’s disease (CD) patients were included. The best performance of FC for predicting MH in UC was at cut-off range of 60–75 μg/g with area under the curve (AUC) of 0.88 and pooled sensitivity and specificity of 0.87 and 0.79, respectively. The pooled sensitivity and specificity values of cutoff range 180–250 μg/g for predicting MH in CD were 0.67 and 0.76, respectively. The AUC of 0.79 also revealed improved discrimination for identifying MH in CD with FC concentration. <b><i>Conclusion:</i></b> Our meta-analysis has found that FC is a simple, reliable noninvasive marker for predicting MH in IBD patients. FC cutoff range 60–75 μg/g appears to have the best overall accuracy in UC patients.

Predictors of Surgical Intervention in Patients with Inflammatory Bowel Disease

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Hamdy Abd El Megeed ◽  
Shereen Abou Bakr Saleh ◽  
Christina Alphonse Anwar ◽  
Ahmed Elkattary Mohamed Elkattary
Keyword(s):  
Inflammatory Bowel Disease ◽  
Surgical Treatment ◽  
Bowel Disease ◽  
Surgical Intervention ◽  
High Sensitivity ◽  
Medical Patients ◽  
Mayo Score ◽  
Calprotectin Level ◽  
Inflammatory Bowel ◽  
The Mean

Abstract Background Inflammatory bowel disease (IBD) is comprised of two major disorders: Ulcerative Colitis and Crohn’s disease. Ulcerative Colitis affects the colon, where as Crohn’s disease can involve any component of the gastrointestinal tract from the mouth to the perianal area. These disorders have somewhat different pathologic and clinical characteristics, but with substantial overlap; their pathogenesis remains poorly understood. Objective To determine & detect different predictors that help us to characterize patients with high probability of undergoing surgical intervention for inflammatory bowel diseases. Patients and Methods The present study was designed to detect & identify possible factors that can be used to predict surgical intervention in patients with IBD. The present study was a case control study that was conducted on 80 patients with inflammatory bowel disease (either controlled by medical treatment or needed surgical intervention as a part of disease control) who were recruited form Ain-Shams university hospitals and El Quabbary general hospital in Alexandria. In the present study, the mean age of the included patients was 36.67 ±8.5 years old and 50% of the patients were males. The mean age at the onset of the disease was 25.81 ±6.8 years old. Results In the present study, there were statistically significant differences between surgical and medical patients in terms of CDAI for CD (p &lt; 0.001) and Mayo score for UC (p &lt; 0.001). Surgical patients were more likely to have higher scores. CDAI and Mayo score were negative predictors of surgical treatment. CDAI score &gt; 287 and Mayo score &gt; 8.5 achieved high sensitivity and specificity for the detection of surgical treatment. In the present study, we found that there was statistically significant differences between surgical and medical patients in terms of Stool Calprotectin level. Surgical patients were more likely to have higher Stool Calprotectin level. Stool Calprotectin level was negative predictor of surgical treatment at a level of &gt; 341.5 microgm/gm with high sensitivity and specificity. Conclusion Surgical treatment is a common outcome in IBD. Certain clinical features and the extent of disease are risk factors for surgical intervention. Our study indicates that smoking, Chron’s disease, perianal disease, granulomas, higher severity scores, higher stool Calprotectin level, CRP, and ESR were associated with higher risks of surgical intervention. In addition, smoking, peri-anal disease, CDAI, Mayo score, Stool Calprotectin level, and CRP level were predictors of surgical treatment. The findings of our analysis have implications for practice, particularly in the promotion of preoperative individualized risk prediction. The ability to predict which patients will need surgery and target more intensive, early treatment to that group would be invaluable. Further research through large prospective cohort studies is needed to confirm our findings and conclusions.

scholarly journals Faecal calprotectin to detect inflammatory bowel disease: a systematic review and exploratory meta-analysis of test accuracy

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e027428 ◽  
Author(s):  
Karoline Freeman ◽  
Brian H Willis ◽  
Hannah Fraser ◽  
Sian Taylor-Phillips ◽  
Aileen Clarke
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Inflammatory Bowel Disease ◽  
Sensitivity And Specificity ◽  
Bowel Disease ◽  
Secondary Care ◽  
Meta Analysis ◽  
Test Accuracy ◽  
Faecal Calprotectin ◽  
Inflammatory Bowel

ObjectiveTest accuracy of faecal calprotectin (FC) testing in primary care is inconclusive. We aimed to assess the test accuracy of FC testing in primary care and compare it to secondary care estimates for the detection of inflammatory bowel disease (IBD).MethodsSystematic review and meta-analysis of test accuracy using a bivariate random effects model. We searched MEDLINE, EMBASE, Cochrane Library and Web of Science until 31 May 2017 and included studies from auto alerts up until 31 January 2018. Eligible studies measured FC levels in stool samples to detect IBD in adult patients with chronic (at least 6–8 weeks) abdominal symptoms in primary or secondary care. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. We followed the protocol registered as PROSPERO CRD 42012003287.Results38 out of 2168 studies were eligible including five from primary care. Comparison of test accuracy by setting was precluded by extensive heterogeneity. Overall, summary estimates of sensitivity and specificity were not recorded. At a threshold of 50 µg/g, sensitivity from separate meta-analysis of four assay types ranged from 0.85 (95% CI 0.75 to 0.92) to 0.94 (95% CI 0.75 to 0.90) and specificity from 0.67 (95% CI 0.56 to 0.76) to 0.88 (95% CI 0.77 to 0.94). Across three different definitions of disease, sensitivity ranged from 0.80 (95% CI 0.76 to 0.84) to 0.97 (95% CI 0.91 to 0.99) and specificity from 0.67 (95% CI 0.58 to 0.75) to 0.76 (95% CI 0.66 to 0.84). Sensitivity appears to be lower in primary care and is further reduced at a revised threshold of 100 µg/g.ConclusionsConclusive estimates of sensitivity and specificity of FC testing in primary care for the detection of IBD are still missing. There is insufficient evidence in the published literature to support the decision to introduce FC testing in primary care. Studies evaluating FC testing in an appropriate primary care setting are needed.

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