American Association of Endocrine SurgeonThe prevalence of undiagnosed and unrecognized primary hyperparathyroidism: A population-based analysis from the electronic medical record
Section snippets
Methods
The study was conducted at a large, academic, healthcare system with 9 hospitals and 13 outpatient clinics. All sites access and document patient care—including patient encounters, diagnostic studies, and laboratory data—using a shared EMR. Diagnoses are entered and updated at the discretion of physicians. We used International Classification of Disease-9 codes to extract diagnosis-related data from problem lists and encounter diagnoses entries for those codes. Current Procedural Terminology
Results
Of 6.5 million medical records searched over a 12-year period, 2.7 million patients had a primary care physician with longitudinal care in our healthcare system and were selected for the study. Of those patients, 2% (54,198 patients) had ≥2 outpatient serum calcium levels of ≥10.6 mg/dL. Because of the large number of records, the study was narrowed to a 2-year period from 2008 to 2009, yielding a study population of 7,269 patients (Fig 1). The study population was then divided into 3
Discussion
A primary objective of our study was to identify the prevalence of unrecognized or undiagnosed PHPT. In our study population of hypercalcemic patients, a large portion (43%) had undiagnosed or unrecognized PHPT with an estimated overall prevalence of 0.86% in the general population. This prevalence is >8 times greater than the commonly reported prevalence of 1 in 1,000 patients (0.1%). We feel that this is likely an underestimation of the prevalence for 2 reasons. First, patients with
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