Diagnostic accuracy of algorithms to define incident and second hip fractures: A Taiwan validation study

Shau-Huai Fu; Ping-Ying Yu; Chung-Yi Li; Chih-Chien Hung; Chia-Che Lee; Hsuan-Yu Chen; Ta-Wei Tai; Jawl-Shan Hwang; Rong-Sen Yang; Hongsen Chiang; Sung-Yen Lin; Chih-Hsing Wu; Ling-Chiao Liao; Chin-Ju Chuang; Chiu-Yi Wu; Cheng-Ying Chang; Ming-Tsung Lee; Chung-Hwan Chen; Chen-Yu Wang

doi:10.1016/j.jfma.2023.05.037

Diagnostic accuracy of algorithms to define incident and second hip fractures: A Taiwan validation study

J Formos Med Assoc. 2023:122 Suppl 1:S82-S91. doi: 10.1016/j.jfma.2023.05.037. Epub 2023 Jun 21.

Authors

Shau-Huai Fu¹, Ping-Ying Yu², Chung-Yi Li³, Chih-Chien Hung⁴, Chia-Che Lee⁵, Hsuan-Yu Chen⁶, Ta-Wei Tai⁷, Jawl-Shan Hwang⁸, Rong-Sen Yang⁹, Hongsen Chiang⁹, Sung-Yen Lin¹⁰, Chih-Hsing Wu¹¹, Ling-Chiao Liao¹², Chin-Ju Chuang¹², Chiu-Yi Wu¹², Cheng-Ying Chang¹², Ming-Tsung Lee¹³, Chung-Hwan Chen¹⁴, Chen-Yu Wang¹⁵

Affiliations

¹ Department of Orthopedics, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Department of General Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
³ Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
⁴ Department of Orthopedics, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan.
⁵ Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.
⁶ Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
⁷ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁸ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
⁹ Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan.
¹⁰ Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
¹¹ Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹² Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan.
¹³ National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, Taiwan; Department of Nursing, Hungkuang University, Taichung, Taiwan.
¹⁴ Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Orthopaedic Research Center and Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital and Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Electronic address: [email protected].
¹⁵ Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: [email protected].

PMID: 37353444
DOI: 10.1016/j.jfma.2023.05.037

Abstract

Background: Previous epidemiological researchers have used various algorithms to identify a second hip fracture; however, there has been no validation of these algorithms to date. This study aimed to verify existing algorithms for identifying second hip fracture under the International Classification of Diseases diagnostic coding systems. Furthermore, we examined the validity of two newly proposed algorithms that integrated the concept of periprosthetic fractures and laterality of the ICD-10 coding system.

Methods: Claims data of patients hospitalized for hip fracture from National Taiwan University Hospitals between 2007 and 2020 were retrieved. Hip fracture was confirmed by 2 orthopaedic surgeons with medical records and imaging data as gold standards. The validity of 9 existing and 2 newly proposed algorithms for identifying second hip fracture was evaluated.

Results: The positive predictive value (PPV) range between 84% and 90% in existing algorithms for identifying second hip fractures. Noteworthy, the longer time interval for discrimination resulted in slightly increased PPV (from 87% to 90%), while decreased sensitivity noticeably (from 87% to 72%). When considering the information about periprosthetic fracture, the PPV increased to 91% without diminished sensitivity. The PPV of the newly proposed ICD-10-specific algorithm was 100%.

Conclusion: Algorithms integrated clinical insights of periprosthetic fractures and laterality concept of ICD-10 coding system provided satisfactory validity and help precisely define second hip fracture in future database research.

Keywords: Diagnostic accuracy; Hip fractures; International classification of diseases; Periprosthetic fracture; Validity.

MeSH terms

Algorithms
Hip Fractures* / diagnosis
Hip Fractures* / epidemiology
Humans
Medical Records
Periprosthetic Fractures*
Taiwan / epidemiology