title: Poor validation of medical record ICD-9 diagnoses of gout in a veterans affairs database.
abstract: OBJECTIVE
  Diagnostic codes based on medical records or claims data have been used to identify patient populations with gout for important epidemiologic and clinical studies. We evaluated whether we can document the accuracy of such diagnoses by review of medical records and then on direct interviews with a subset of patients.
  
  
  METHODS
  Electronic medical records of 289 patients with 2 visits with ICD-9 codes for gout were extensively reviewed to search for documentation of features that would classify patients as having gout by 3 sets of proposed criteria, the American College of Rheumatology (ACR), New York, or Rome criteria. Records of patients who had been seen by rheumatologists were compared with all others. A subset of patients seen in clinic were directly interviewed for comparison with the results from the records.
  
  
  RESULTS
  Based on medical records review there was documentation of gout by the ACR criteria in only 36%, Rome criteria in 30%, and New York criteria in 33%. Records of patients who had seen rheumatologists had better documentation of classification features. Interview in clinic of 37 patients also improved documentation of the 3 sets of criteria features of gout in 65%-81% of those with ICD-9 codes for gout.
  
  
  CONCLUSIONS
  We found it difficult to confirm ICD-9 coded diagnoses of gout using currently available proposed criteria from details recorded in medical records. This may reflect a problem with available criteria and with documentation. Direct interview of patients may be needed to confirm the presence of typical features when high specificity is desired.
authors.affiliation: University of Pennsylvania and Veterans Affairs Medical Center, Philadelphia, PA, USA.
authors.forename: Aarti
authors.initials: A
authors.lastname: Malik
authors.forename: Janet E
authors.initials: JE
authors.lastname: Dinnella
authors.forename: C Kent
authors.initials: CK
authors.lastname: Kwoh
authors.forename: H Ralph
authors.initials: HR
authors.lastname: Schumacher
mesh_terms: D019992:Databases as Topic; D006073:Gout / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008499:Medical Records / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*; D014729:Veterans Disability Claims