EPR-Val Test Pack Version 2*
*NOTE (2 Aug 2001): The EPR-Val toolkit has been modified to correct an error in the calculation of confidence intervals. We recommend that
users upgrade from EPR-Val to EPR-Val Version 2. (You need MS Excel to view this file)
Morbidity validation—diagnostic criteria for the 15 test conditions
The main search for the test conditions was performed against the appropriate Read code(s) for each condition. Triangulation against specific drug and/or treatment codes was performed to validate the diagnosis and calculate the test statistics for each condition
· Breast cancer—High-level Read code for breast cancer, plus all daughter codes and/or mastectomy and/or prescription of any of the following; tamoxifen, aminoglutethimide, anastrozole, formestane, letrozole and toremifene. Also triangulate against Read codes for radiotherapy and/or chemotherapy. 99% of breast cancer occurs in women.
· Prostate cancer—High level Read code for prostate cancer, plus all daughter codes and/or total prostatectomy and/or orchidectomy and/or prescription of any of the following; diethylstilbestrol, bicalutamide, buserelin, cyproterone, flutamide, goserelin, leuprorelin and triptorelin. Also triangulate against Read codes for radiotherapy and/or chemotherapy. Prostate disease occurs only in men.
· Diabetes mellitus—High level Read code for diabetes mellitus, plus all daughter codes and/or complication codes (e.g. diabetic retinopathy, nephropathy, neuropathy) and/or prescription of any of the following drug groups; insulins, biguanides, sulphonylureas, diagnostic, monitoring agents for diabetes, hypodermic equipment, drugs used in the treatment of hypoglycaemia and/or fasting blood sugar >7 mmol/l and/or random blood sugar >11.1 mmol/l.
· Obesity—High level Read code for obesity, plus all daughter codes and/or body mass index >30 kg/m2 and/or prescription of either of the following; orlistat and phentermine.
· Hypothyroidism—High level read code for hypothyroidism and/or goitre, plus all daughter codes and/or prescription of thyroxine and/or serum thyroid stimulating hormone (TSH) >6.9 mIU/l.
· Hyperthyroidism—High level Read code for hyperthyroidism, plus all daughter codes and/or prescription of either of the following; carbimazole and/or propylthiouracil and/or serum thyroxine >25.6 pmol/l. Also triangulate against Read codes for thyroidectomy.
· Gout—High level Read code for gout, plus all daughter codes and/or prescription of any of the following; indomethacin, allopurinol, colchicine, probenecid and sulfinpyrazone and/or serum urate >0.44 mmol/l (male) >0.35 mmol/l (female).
· Iron deficiency anaemia—High level Read code for iron deficiency anaemia, plus all daughter codes and/or prescription of iron preparations and/or serum ferritin <10 ng/ml.
· Glaucoma—High level Read code for glaucoma, plus all daughter codes and/or prescriptions for any of the following eye preparations; carbachol, pilocarpine, adrenaline/epinephrine, brimonidine, dipivefrine, guanethidine, betaxolol, cateolol, levobunolol, metipranolol, timolol, orzolamide and latanoprost.
· Epilepsy—High level Read code for epilepsy, plus all daughter codes and/or prescription of any of the following; carbamazepine, clobazam, clonazepam, diazepam rectal tubes, ethosuximide, lamotrigine, phenobarbital, primidone, phenytoin, topirimate, valproate and vigabatrin.
· Parkinson’s disease—High level Read code for Parkinson’s disease, plus all daughter codes and/or prescription of any of the following; levodopa/decarboxylase preparations, selegiline, entacapone, bromocriptine, cabergomine, lisuride, pergolide, ropinirole, pramipexole, amantadine, apomorphine, orphenadrine, benzhexol, benzatropine and procyclidine.
· Ischaemic heart disease—High level Read code for ischaemic heart disease, plus all daughter codes and/or codes for related diagnoses and treatments (e.g. angina, myocardial infarction, heart failure, coronary artery bypass graft, coronary angiography, coronary angioplasty, aspirin prophylaxis advice, ischaemic heart disease screening) and/or prescription of any of the following drug groups; nitrates, aspirin, statins, calcium channel blockers, ACE inhibitors, loop diuretics and potassium channel activators. This list of drug treatments reflects recent prescribing practice at the FMC and is not an exhaustive list of drug treatments for ischaemic heart disease.
· Hypertension—High level Read code for hypertension, plus all daughter codes and/or blood pressure >150/90 mm Hg (British Hypertension Society 1999) and/or prescription of any of the following; atenolol, labetalol, metoprolol, α adrenoceptor blocking drugs and thiazide diuretics. This list of drug treatments reflects recent prescribing practice at the FMC and is not an exhaustive list of drug treatments for hypertension.
· Asthma—High level Read code for asthma, plus all daughter codes and/or prescription of any of the following drug groups; selective β2 adrenoceptor stimulants, antimuscarinic bronchodilators, theophyllines, inhaled corticosteroids, cromoglycates and leukotriene receptor antagonists, but excluding the diagnosis of chronic obstructive pulmonary disease (COPD).
· Rheumatoid arthritis—High level
Read code for rheumatoid arthritis, plus all daughter codes and/or prescription
of any of the following drugs; myocrisin, penicillamine, chloroquine, hydroxychloroquine,
azothioprine, methotrexate and sulphasalazine and/or seropositive rheumatoid
factor.
Contingency tables for the 15 diagnoses
Test condition = breast cancer | Test Condition | ||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = prostate cancer | Test Condition | ||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = diabetes mellitus | Test Condition | ||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = obesity | Test Condition | ||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = hypothyroidism | Test Condition | ||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = Hyperthyroidism | Test Condition | ||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = gout | Test Condition | ||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = Iron deficiency anaemia | |||||
Test Condition | |||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = Glaucoma | Test Condition | ||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = Epilepsy | Test Condition | ||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = Parkinson's disease | |||||
Test Condition | |||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = Ischaemic heart disease | |||||
Test Condition | |||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = Hypertension | Test Condition | ||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = Asthma | Test Condition | ||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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Test condition = Rheumatoid arthritis | |||||
Test Condition | |||||
Present | Absent | Totals | |||
| Present |
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| Absent |
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Totals |
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