Abstract
Background: Though administrative databases are increasingly being used for research related to myocardial infarction (MI),
the validity of MI diagnoses in these databases has never been synthesized on a large scale.
Objective: To conduct the first systematic review of studies reporting on the validity of diagnostic codes for identifying MI
in administrative data.

Methods: MEDLINE and EMBASE were searched (inception to November 2010) for studies: (a) Using administrative data to
identify MI; or (b) Evaluating the validity of MI codes in administrative data; and (c) Reporting validation statistics (sensitivity,
specificity, positive predictive value (PPV), negative predictive value, or Kappa scores) for MI, or data sufficient for their
calculation. Additonal articles were located by handsearch (up to February 2011) of original papers. Data were extracted by
two independent reviewers; article quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool.

Results: Thirty studies published from 1984–2010 were included; most assessed codes from the International Classification
of Diseases (ICD)-9th revision. Sensitivity and specificity of hospitalization data for identifying MI in most [$50%] studies was
$86%, and PPV in most studies was $93%. The PPV was higher in the more-recent studies, and lower when criteria that do
not incorporate cardiac troponin levels (such as the MONICA) were employed as the gold standard. MI as a cause-of-death
on death certificates also demonstrated lower accuracy, with maximum PPV of 60% (for definite MI).

Conclusions: Hospitalization data has higher validity and hence can be used to identify MI, but the accuracy of MI as a
cause-of-death on death certificates is suboptimal, and more studies are needed on the validity of ICD-10 codes. When
using administrative data for research purposes, authors should recognize these factors and avoid using vital statistics data
if hospitalization data is not available to confirm deaths from MI.

Received September 29, 2013; Accepted February 20, 2014; Published March 28, 2014

Citation: McCormick N, Lacaille D, Bhole V, Avina-Zubieta JA (2014) Validity of Myocardial Infarction Diagnoses in Administrative Databases: A Systematic
Review. PLoS ONE 9(3): e92286. doi:10.1371/journal.pone.0092286