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Original Research: COPD |

The Inaccuracy of Patient Recall for COPD Exacerbation Rate Estimation and Its Implications: Results from Central Adjudication

Anja Frei, PhD; Lara Siebeling, PhD; Callista Wolters, MD; Leonhard Held, PhD; Patrick Muggensturm, MD; Alexandra Strassmann, MSc; Marco Zoller, MD; Gerben ter Riet, MD, PhD; Milo A. Puhan, MD, PhD
Author and Funding Information

Gerben ter Riet and Milo A. Puhan contributed equally as senior authors.

FUNDING SUPPORT: This study is part of the prospective International Collaborative Effort on Chronic Obstructive Lung Disease: Exacerbation Risk Index Cohorts (ICE COLD ERIC) cohort study, which was supported by the Swiss National Science Foundation [Grant No. 3233B0/115216/1], Lung Foundation Netherlands [Grant No. 3.4.07.045], Stichting Astmabestrijding [Grant No. SAB 2012/043], and Zurich Lung League [unrestricted grant].

aEpidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland

bDepartment of Internal Medicine, Zollikerberg Hospital, Zollikon, Switzerland

cDepartment of General Practice, Academic Medical Center, University of Amsterdam, the Netherlands

dInstitute of General Practice and Health Services Research, University of Zurich, Switzerland

CORRESPONDENCE TO: Anja Frei, PhD, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zürich, Switzerland


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4):860-868. doi:10.1016/j.chest.2016.06.031
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Background  COPD exacerbation incidence rates are often ascertained retrospectively through patient recall and self-reports. We compared exacerbation ascertainment through patient self-reports and single-physician chart review to central adjudication by a committee and explored determinants and consequences of misclassification.

Methods  Self-reported exacerbations (event-based definition) in 409 primary care patients with COPD participating in the International Collaborative Effort on Chronic Obstructive Lung Disease: Exacerbation Risk Index Cohorts (ICE COLD ERIC) cohort were ascertained every 6 months over 3 years. Exacerbations were adjudicated by single experienced physicians and an adjudication committee who had information from patient charts. We assessed the accuracy (sensitivities and specificities) of self-reports and single-physician chart review against a central adjudication committee (AC) (reference standard). We used multinomial logistic regression and bootstrap stability analyses to explore determinants of misclassifications.

Results  The AC identified 648 exacerbations, corresponding to an incidence rate of 0.60 ± 0.83 exacerbations/patient-year and a cumulative incidence proportion of 58.9%. Patients self-reported 841 exacerbations (incidence rate, 0.75 ± 1.01; incidence proportion, 59.7%). The sensitivity and specificity of self-reports were 84% and 76%, respectively, those of single-physician chart review were between 89% and 96% and 87% and 99%, respectively. The multinomial regression model and bootstrap selection showed that having experienced more exacerbations was the only factor consistently associated with underreporting and overreporting of exacerbations (underreporters: relative risk ratio [RRR], 2.16; 95% CI, 1.76-2.65 and overreporters: RRR, 1.67; 95% CI, 1.39-2.00).

Conclusions  Patient 6-month recall of exacerbation events are inaccurate. This may lead to inaccurate estimates of incidence measures and underestimation of treatment effects. The use of multiple data sources combined with event adjudication could substantially reduce sample size requirements and possibly cost of studies.

Clinical Trial Registration  www.ClinicalTrials.gov, NCT00706602

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