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Further details

Diagnoses

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 cancerTest Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    54
    0
    54
     
    Read Code + or -
    Absent
    3
    13544
    13547
      Totals
    57
    13544
    13601

     
     Test condition = prostate cancer Test Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    24
    1
    25
     
    Read Code + or -
    Absent
    0
    13576
    13576
      Totals
    24
    13577
    13601

     
     Test condition = diabetes mellitusTest Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    286
    2
    288
     
    Read Code + or -
    Absent
    5
    13300
    13305
      Totals
    291
    13302
    13593

     
     Test condition = obesity Test Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    17
    2
    19
     
    Read Code + or -
    Absent
    794
    12789
    13583
      Totals
    811
    12791
    13602

     
     Test condition = hypothyroidismTest Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    193
    5
    198
     
    Read Code + or -
    Absent
    42
    13366
    13408
      Totals
    235
    13371
    13606

     
     Test condition = HyperthyroidismTest Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    47
    2
    49
     
    Read Code + or -
    Absent
    1
    13545
    13546
      Totals
    48
    13547
    13595

     
     Test condition = gout Test Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    207
    5
    212
     
    Read Code + or -
    Absent
    14
    13379
    13393
      Totals
    221
    13384
    13605

     
     Test condition = Iron deficiency anaemia   
       Test Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    149
    5
    154
     
    Read Code + or -
    Absent
    43
    13399
    13442
      Totals
    192
    13404
    13596

     
     Test condition = Glaucoma Test Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    107
    5
    112
     
    Read Code + or -
    Absent
    4
    13486
    13490
      Totals
    111
    13491
    13602

     
     Test condition = Epilepsy Test Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    79
    4
    83
     
    Read Code + or -
    Absent
    5
    13516
    13521
      Totals
    84
    13520
    13604

     
     Test condition = Parkinson's disease   
       Test Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    26
    1
    27
     
    Read Code + or -
    Absent
    4
    13568
    13572
      Totals
    30
    13569
    13599

     
     Test condition = Ischaemic heart disease   
       Test Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    681
    20
    701
     
    Read Code + or -
    Absent
    32
    12862
    12894
      Totals
    713
    12882
    13595

     
     Test condition = Hypertension Test Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    871
    10
    881
     
    Read Code + or -
    Absent
    20
    12695
    12715
      Totals
    891
    12705
    13596

     
     Test condition = Asthma Test Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    630
    100
    730
     
    Read Code + or -
    Absent
    92
    12774
    12866
      Totals
    722
    12874
    13596

     
     Test condition = Rheumatoid arthritis   
       Test Condition 
       PresentAbsentTotals
     
    Test for condition
    Present
    94
    8
    102
     
    Read Code + or -
    Absent
    1
    13493
    13494
      Totals
    95
    13501
    13596