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

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.