RT Journal Article
SR Electronic
T1 Effects of diagnostic uncertainty and misclassification on hospital performance indicators for acute stroke care
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 597
OP 600
DO 10.7861/clinmedicine.14-6-597
VO 14
IS 6
A1 David Barer
A1 Tim Cassidy
YR 2014
UL http://www.rcpjournals.org/content/14/6/597.abstract
AB The Stroke Improvement National Audit Programme (SINAP), now replaced by the Sentinel Stroke National Audit Programme, was established to provide comparative data on hospital performance indicators for stroke, but comparisons are only valid if case ascertainment is complete. In Gateshead we compared initial results from SINAP with those from a pre-existing hospital stroke register, which ran independently for 11 months after SINAP's introduction in 2010, as well as with Hospital Episode Statistics (HES) data. Of 315 confirmed acute stroke cases identified from the three combined data sources, 96 (30%) were omitted from SINAP and 51 (16%) were missed by HES. Of 478 suspected strokes in the combined datasets, 214 were either misclassified by HES or remained with uncertain diagnosis. These patients had much lower mortality and shorter hospital stays than those with confirmed stroke. This diagnostic uncertainty could be an important source of uncontrolled variation in, or even a potential target for manipulation of, hospital performance indicators for stroke.