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A main limitation of our study is the medical encounter database nature of its design and reliance on ICD-9 coding which may increase the risk for misclassification.
Interpretation of these results should be done with a full appreciation of potential biases inherent with medical encounter database studies, as well as the population under study.
We utilized a US Department of Defense medical encounter database to evaluate the risk of several gastrointestinal disorders following select foodborne infections.
Utilization of a medical encounter database for epidemiologic studies carries an intrinsic risk of misclassification or systemic biases, in addition to those described specifically above.
First, the use of a medical encounter database is a potential source for misclassifications of exposure, outcome and other covariates due to inaccurate ICD-9 or CPT coding.
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The US Department of Defense's Armed Forces Health Surveillance Center AFHSCC) maintains comprehensive medical encounter databases on all service members as part of surveillance and public health efforts: the Defense Medical Surveillance System (DMSS) and the Defense Medical Encounter Database (DMED) [ 9].
Large automated medical encounter databases are therefore a valuable data source for observational studies of DKA risk related to atypical antipsychotic drug use, particularly for relatively under-studied patient sub-groups including children and youth [ 6].
Medical information and demographic data were obtained from inpatient and outpatient medical encounter and personnel databases by the Defense Medical Surveillance Center, The Armed Forces Health Surveillance Center, U.S. Department of Defense, Silver Spring, Maryland [inclusive dates:1998-2010; release date: March 2012].
Most automated databases, including the one used in our study, include medical encounter and healthcare service utilization data that were not collected specifically for research purposes.
Most automated databases, including the one used in our study, are made up of medical encounter and other service utilization data are collected for purposes other than research, and the quality of the collected data can vary substantially [ 7].
The control's medical encounter had to occur within 3 days of the case's medical encounter.
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