Pediatric acquired demyelinating syndromes: a nationwide validation study of the Danish National Patient Register

Abstract

Magnus Spangsberg Boesen,1 Melinda Magyari,2,3 Alfred Peter Born,1 Lau Caspar Thygesen4 1Department of Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 2The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; 3Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 4National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark Objective: To validate the Danish National Patient Register’s (NPR) diagnoses of pediatric acquired demyelinating syndromes (ADS) including multiple sclerosis (MS). Study design and setting: We identified ADS diagnostic groups using International Classification of Diseases (ICD) codes and reviewed medical records to validate the NPR diagnoses during 2008–2015. Results: Among 409 children in the study, 184 children had a validated and final ADS diagnosis after reviewing medical records as follows: optic neuritis (ON; n=46), transverse myelitis (TM; n=16), acute disseminated encephalomyelitis (ADEM; n=50), clinically isolated syndrome (CIS) including dissemination in space (CIS [DIS]) but not dissemination in time (n=6), neuromyelitis optica spectrum disorder (NMOsd; n=5), and MS (n=61). During the mean follow-up of 4.6 years, 33% of children initially diagnosed with monophasic ADS progressed to MS. Positive predictive value (PPV) was 0.71 (95% confidence interval [CI] =0.62–0.80) for ON, 0.64 (95% CI =0.43–0.82) for TM, 0.93 (95% CI =0.84–0.98) for MS, 0.27 (95% CI =0.19–0.35) for CIS, 0.43 (95% CI =0.10–0.82) for NMOsd, and 0.15 (95% CI =0.10–0.20) for ADEM. Assuming complete coverage for non-MS ADS, the sensitivity was 0.99 (95% CI =0.93–1.00) for ON, 0.83 (95% CI =0.36–1.00) for CIS (DIS), and 0.80 (95% CI =0.56–0.94) for TM, but only 0.58 (95% CI =0.43–0.72) for ADEM and 0.60 (95% CI =0.15–0.95) for NMOsd. Conclusion: PPV was high for MS and considered acceptable for ON and TM; therefore, these ICD revision 10 (ICD-10) codes from the NPR are useful for epidemiological studies. Conversely, PPV was low for CIS and ADEM; NMOsd was inconclusive. Keywords: pediatric MS, acquired demyelinating syndrome, ADEM, health registers, validation, ICD-10