Journal Article

Comparison of Active and Passive Surveillance for Cerebrovascular Disease

Paisith Piriyawat, Miriam Šmajsová, Melinda A. Smith, Sanjay Pallegar, Areej Al-Wabil, Nelda M. Garcia, Jan M. Risser, Lemuel A. Moyé and Lewis B. Morgenstern

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 156, issue 11, pages 1062-1069
Published in print December 2002 | ISSN: 0002-9262
Published online December 2002 | e-ISSN: 1476-6256 | DOI:
Comparison of Active and Passive Surveillance for Cerebrovascular Disease

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To provide a scientific rationale for choosing an optimal stroke surveillance method, the authors compared active surveillance with passive surveillance. The methods involved ascertaining cerebrovascular events that occurred in Nueces County, Texas, during calendar year 2000. Active methods utilized screening of hospital and emergency department logs and routine visiting of hospital wards and out-of-hospital sources. Passive means relied on International Classification of Diseases, Ninth Revision (ICD-9), discharge codes for case ascertainment. Cases were validated by fellowship-trained stroke neurologists on the basis of published criteria. The results showed that, of the 6,236 events identified through both active and passive surveillance, 802 were validated to be cerebrovascular events. When passive surveillance alone was used, 209 (26.1%) cases were missed, including 73 (9.1%) cases involving hospital admission and 136 (17.0%) out-of-hospital strokes. Through active surveillance alone, 57 (7.1%) cases were missed. The positive predictive value of active surveillance was 12.2%. Among the 2,099 patients admitted to a hospital, passive surveillance using ICD-9 codes missed 73 cases of cerebrovascular disease and mistakenly included 222 noncases. There were 57 admitted hospital cases missed by active surveillance, including 13 not recognized because of human error. This study provided a quantitative means of assessing the utility of active and passive surveillance for cerebrovascular disease. More uniform surveillance methods would allow comparisons across studies and communities.

Keywords: cerebral hemorrhage; cerebrovascular accident; cerebrovascular disorders; epidemiologic methods; population surveillance; Abbreviations: BASIC, Brain Attack Surveillance in Corpus Christi; ICD-9, International Classification of Diseases, Ninth Revision; ICD-10, International Classification of Diseases, Tenth Revision.

Journal Article.  4605 words.  Illustrated.

Subjects: Public Health and Epidemiology

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