Quality Assessment of the Iran Intensive Care Unit Registry: A Validation Evaluation Using International Medical Registry Frameworks (2017-2024).

Background: The Iran intensive care unit registry (IICUR) was established to systematically collect highquality clinical data from critically ill adult patients nationwide. This registry was created to fill a major gap in Iran by providing the first coordinated national intensive care unit (ICU) data system to support benchmarking, quality improvement, and research. This study aimed to assess the registry's data quality, representativeness, and performance using internationally recognized evaluation frameworks. Methods: This validation study included consecutive adult ICU admissions (aged≥16 years) recorded in the IICUR between October 2017 and October 2024 across 39 ICUs in 16 hospitals from various regions of Iran. Data quality was assessed based on the directory of clinical databases (DoCDat) and Arts et al., frameworks. Evaluated domains included case representativeness, variable completeness, data validation processes, and coding reliability. Statistical analyses were performed using SPSS software (version 24). Results: Overall, 34,550 ICU admissions were registered (36% surgical, 64% medical). The patient's mean age was 49.4 years, with an average ICU stay of 6.7 days. The registry achieved a median DoCDat score of 3.0 (on a 1-4 scale), indicating strong national coverage, standardized data definitions, and high recruitment completeness. Trauma, neurological, and respiratory disorders were the most common admission causes. ICU and hospital mortality rates were 13.8% and 16.4%, respectively. Despite its strengths, enhanced data validation and postdischarge followup were required. Conclusion: The IICUR demonstrated high methodological standards, providing a robust national platform for benchmarking, policy development, and critical care research in Iran.