Validation of emergency and final diagnosis coding in transient ischemic attack: South Western Sydney transient ischemic attack study.
BACKGROUND
It is important to establish the validity of diagnostic coding in administrative datasets used in stroke and transient ischemic attack (TIA) research. This study examines the accuracy of emergency department (ED) TIA diagnosis and final diagnostic coding after hospital admission.


METHODS
Using administrative datasets, we identified all patients with an ED TIA diagnosis (435.9; ICD-9) admitted to Liverpool Hospital from January 2003 to December 2007. ED and hospital admission records were matched and final diagnosis codes (ICD-10-AM) recorded. All records were expertly reviewed to determine coding validity.


RESULTS
570 patients were admitted with an ED TIA diagnosis. According to ICD-10-AM coding, 46% had TIA, 29% stroke and 25% TIA mimic diagnoses. Expert review determined final diagnoses of TIA in 51.4%, stroke in 26.1% and TIA mimic in 22.5% of the patients. The positive predictive value of a final TIA diagnosis (ICD-10-AM) was 88.2% when subjected to expert review. TIA mimic disorders diagnosed after admission included serious conditions.


CONCLUSIONS
Half of the emergency diagnoses retained a TIA diagnosis after hospital admission. In the setting of neurological admission there were small percentage differences between coded final diagnosis for TIA, stroke and mimic and diagnoses at expert review. Admission of ED TIA cases permitted identification of TIA mimics with serious conditions requiring non-TIA management.
Ghia
Darshan
D
Department of Neurology, Liverpool Hospital and South Western Sydney Clinical School, University of New South Wales, Liverpool, N.S.W., Australia.
Thomas
Peter R
PR
Cordato
Dennis J
DJ
Worthington
John M
JM
Cappelen-Smith
Cecilia
C
Griffith
Neil
N
Hanna
Ibrahim
I
Hodgkinson
Suzanne J
SJ
McDougall
Alan
A
Beran
Roy G
RG
D016208:Databases, Factual; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D002546:Ischemic Attack, Transient / Q000175:diagnosis*; D008297:Male; D009517:New South Wales; D020521:Stroke / Q000175:diagnosis*