• Shau-Huai Fu, Ping-Ying Yu, Chung-Yi Li, Chih-Chien Hung, Chia-Che Lee, Hsuan-Yu Chen, Ta-Wei Tai, Jawl-Shan Hwang, Rong-Sen Yang, Hongsen Chiang, Sung-Yen Lin, Chih-Hsing Wu, Ling-Chiao Liao, Chin-Ju Chuang, Chiu-Yi Wu, Cheng-Ying Chang, Ming-Tsung Lee, Chung-Hwan Chen, and Chen-Yu Wang.
• Department of Orthopedics, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
• J Formos Med Assoc. 2023 Jan 1; 122 Suppl 1: S82S91S82-S91.

BackgroundPrevious epidemiological researchers have used various algorithms to identify a second hip fracture; however, there has been no validation of these algorithms to date. This study aimed to verify existing algorithms for identifying second hip fracture under the International Classification of Diseases diagnostic coding systems. Furthermore, we examined the validity of two newly proposed algorithms that integrated the concept of periprosthetic fractures and laterality of the ICD-10 coding system.MethodsClaims data of patients hospitalized for hip fracture from National Taiwan University Hospitals between 2007 and 2020 were retrieved. Hip fracture was confirmed by 2 orthopaedic surgeons with medical records and imaging data as gold standards. The validity of 9 existing and 2 newly proposed algorithms for identifying second hip fracture was evaluated.ResultsThe positive predictive value (PPV) range between 84% and 90% in existing algorithms for identifying second hip fractures. Noteworthy, the longer time interval for discrimination resulted in slightly increased PPV (from 87% to 90%), while decreased sensitivity noticeably (from 87% to 72%). When considering the information about periprosthetic fracture, the PPV increased to 91% without diminished sensitivity. The PPV of the newly proposed ICD-10-specific algorithm was 100%.ConclusionAlgorithms integrated clinical insights of periprosthetic fractures and laterality concept of ICD-10 coding system provided satisfactory validity and help precisely define second hip fracture in future database research.Copyright © 2023. Published by Elsevier B.V.

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