scholarly journals How Reliable Are Administrative Data for Capturing Stroke Patients and Their Care

2016 ◽  
Vol 6 (3) ◽  
pp. 96-106 ◽  
Author(s):  
Joan Porter ◽  
Luke Mondor ◽  
Moira K. Kapral ◽  
Jiming Fang ◽  
Ruth E. Hall
Keyword(s):  
Ischemic Stroke ◽  
Administrative Data ◽  
Stroke Risk ◽  
Billing Data ◽  
Stroke Risk Factors ◽  
Physician Billing ◽  
Stroke Type ◽  
Hospital Administrative ◽  
Kappa Agreement ◽  
Hospital Administrative Data

Background/Aims: The reliability of diagnostic coding of acute stroke and transient ischemic attack (TIA) in administrative data is uncertain. The purpose of this study is to determine the agreement between administrative data sources and chart audit for the identification of stroke type, stroke risk factors, and the use of hospital-based diagnostic procedures in patients with stroke or TIA. Methods: Medical charts for a population-based sample of patients (n = 14,508) with ischemic stroke, intracerebral hemorrhage (ICH), or TIA discharged from inpatient and emergency departments (ED) in Ontario, Canada, between April 1, 2012 and March 31, 2013, were audited by trained abstractors. Audited data were linked and compared with hospital administrative data and physician billing data. The positive predictive value (PPV) of hospital administrative data and kappa agreement for the reporting of stroke type were calculated. Kappa agreement was also determined for stroke risk factors and for select stroke-related procedures. Results: The PPV for stroke type in inpatient administrative data ranged from 89.5% (95% CI 88.0-91.0) for TIA, 91.9% (95% CI 90.2-93.5) for ICH, and 97.3% (95% CI 96.9-97.7) for ischemic stroke. For ED administrative data, PPV varied from 78.8% (95% CI 76.3-81.2) for ischemic, 86.3% (95% CI 76.8-95.7) for ICH, and 95.3% (95% CI 94.6-96.0) for TIA. The chance-corrected agreement between the audited and administrative data was good for atrial fibrillation (k = 0.60) and very good for diabetes (k = 0.86). Hospital administrative data combined with physician billing data more than doubled the observed agreement for carotid imaging (k = 0.65) and echocardiography (k = 0.66) compared to hospital administrative data alone. Conclusions: Inpatient and ED administrative data were found to be reliable in the reporting of the International Classification of Diagnosis, 10th revision, Canada (ICD-10-CA)-coded ischemic stroke, ICH and TIA, and for the recording of atrial fibrillation and diabetes. The combination of physician billing data with hospital administrative data greatly improved the capture of some diagnostic services provided to inpatients.

Abstract WP182: Trends in Acute Ischemic Stroke Hospitalizations and Risk Factors Among Young Adults: 12 Years of Nationally Representative Data

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Urvish K Patel ◽  
Priti Poojary ◽  
Vishal Jani ◽  
Mandip S Dhamoon
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Stroke Risk ◽  
Behavioral Risk Factors ◽  
Behavioral Risk ◽  
Stroke Risk Factors

Background: There is limited recent population-based data of trends in acute ischemic stroke (AIS) hospitalization rates among young adults (YA). Rising prevalence of stroke risk factors may increase stroke rates in YA. We hypothesized that 1) stroke hospitalizations and mortality among YA are increasing over time (2000-2011), 2) besides traditional stroke risk factors, non-traditional factors are associated with stroke in YA, 3) stroke hospitalization among YA is associated with higher mortality, length of stay (LOS), and cost. Methods: In the Nationwide Inpatient Sample database (years 2000-2011), adult hospitalizations for AIS and concurrent diagnoses were identified by ICD-9-CM codes; the analytic cohort constituted all AIS hospitalizations. We performed weighted analysis using chi-square, t-test, and Jonckheere trend test. Multivariable survey regression models evaluated interactions between age group (18-45 vs. >45 years) and traditional and non-traditional risk factors, with outcomes including mortality, LOS, and cost. Models were adjusted for race, sex, Charlson’s Comorbidity Index, primary payer, location and teaching status of hospital, and admission day. Results: Among 5220960 AIS hospitalizations, 231858 (4.4%) were YA. On trend analysis, proportion of YA amongst AIS increased from 3.6% in 2000 to 4.7% in 2011 (p<0.0001) but mortality in YA decreased from 3.7% in 2000 to 2.6% in 2011, compared to 7.1% in 2000 to 4.6% in 2011 (p<0.0001) among older adults. Non-traditional, especially behavioral, risk factors were more common among YA, and LOS and cost were higher (Table). Conclusion: There was a trend for higher proportion of YA among AIS hospitalizations, though there was a decreasing mortality trend over 10 years. Behavioral risk factors were more common among YA, and there was an increased length of stay and cost. AIS in YA may require different preventive approaches compared to AIS among older adults.

Abstract T P153: Women and Men with Ischemic Stroke in SiGN Have Different Subtype Distributions and Risk Factors

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kathryn M Rexrode ◽  
Braxton D Mitchell ◽  
Kathleen A Ryan ◽  
Steven J Kittner ◽  
Hakan Ay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Cardioembolic Stroke ◽  
Relative Distribution ◽  
Large Artery ◽  
Stroke Risk Factors ◽  
Stroke Subtypes ◽  
Small Artery Occlusion ◽  
Ischemic Stroke Risk

Introduction: The relative distribution of stroke risk factors, as well as ischemic stroke subtypes, in women compared with men is not well described. Hypothesis: We hypothesized that the distribution of ischemic stroke risk factors and subtypes would differ by sex, with a later onset in women and greater proportion of comorbidities. Methods: The NINDS Stroke Genetics Network (SiGN) consortium was established to evaluate genetic risk factors for ischemic stroke. A total of 23 separate studies performed Causative Classification of Stroke (CCS) typing using standardized criteria on ischemic stroke cases and contributed data on risk factors. We compared the distribution of ischemic stroke risk factors and CCS phenotypes between men and women with ischemic stroke. Results: Of the 16,228 ischemic strokes in SiGN, 8005 (49.3%) occurred in women. Median age at stroke was older in female than male stroke cases (73 vs. 66 years) (p=<0.0001). Among stroke cases, women were more likely than men cases to have hypertension or atrial fibrillation and less likely to have diabetes or coronary artery disease, or to smoke (p <0.003 for all). The distribution of stroke subtypes also differed by sex, with women less likely than men to have large artery infarction and small artery occlusion, and more likely to have cardioembolic stroke and undetermined stroke due to incomplete work-up (p values all <0.0001; see Table). Results were similar when the distribution of stroke subtypes was examined for those <70 years and ≥70 years, except for cardioembolic stroke remaining more common only among women ≥70. Conclusions: In this large group of carefully phenotyped ischemic strokes, the distribution of ischemic stroke subtypes and risk factor profiles differ significantly by sex. Evaluation of the causes of these differences may highlight areas for improved prevention and risk reduction in both genders.

scholarly journals Establishing a composite neonatal adverse outcome indicator using English hospital administrative data

2018 ◽  
Vol 104 (5) ◽  
pp. F502-F509 ◽  
Author(s):  
Hannah Ellin Knight ◽  
Sam J Oddie ◽  
Katie L Harron ◽  
Harriet K Aughey ◽  
Jan H van der Meulen ◽  
...  
Keyword(s):  
Data Quality ◽  
Predictive Validity ◽  
Administrative Data ◽  
Adverse Outcome ◽  
First Year ◽  
Risk Of Death ◽  
Outcome Indicator ◽  
Hospital Administrative ◽  
First Year Of Life ◽  
Hospital Administrative Data

ObjectiveWe adapted a composite neonatal adverse outcome indicator (NAOI), originally derived in Australia, and assessed its feasibility and validity as an outcome indicator in English administrative hospital data.DesignWe used Hospital Episode Statistics (HES) data containing information infants born in the English National Health Service (NHS) between 1 April 2014 and 31 March 2015. The Australian NAOI was mapped to diagnoses and procedure codes used within HES and modified to reflect data quality and neonatal health concerns in England. To investigate the concurrent validity of the English NAOI (E-NAOI), rates of NAOI components were compared with population-based studies. To investigate the predictive validity of the E-NAOI, rates of readmission and death in the first year of life were calculated for infants with and without E-NAOI components.ResultsThe analysis included 484 007 (81%) of the 600 963 eligible babies born during the timeframe. 114/148 NHS trusts passed data quality checks and were included in the analysis. The modified E-NAOI included 23 components (16 diagnoses and 7 procedures). Among liveborn infants, 5.4% had at least one E-NAOI component recorded before discharge. Among newborns discharged alive, the E-NAOI was associated with a significantly higher risk of death (0.81% vs 0.05%; p<0.001) and overnight hospital readmission (15.7% vs 7.1%; p<0.001) in the first year of life.ConclusionsA composite NAOI can be derived from English hospital administrative data. This E-NAOI demonstrates good concurrent and predictive validity in the first year of life. It is a cost-effective way to monitor neonatal outcomes.

scholarly journals Parathyroid Hormone Levels in the Prediction of Ischemic Stroke Risk

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Güner Çelik ◽  
Ali Doğan ◽  
Şefik Dener ◽  
Şerefnur Öztürk ◽  
Sevsen Kulaksızoğlu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Risk ◽  
Blood Chemistry ◽  
Dihydroxyvitamin D ◽  
Stroke Risk Factors ◽  
Ischemic Stroke Risk ◽  
Age Range ◽  
The Relationship ◽  
Estimation Models

Objective. It was examined whether PTH and 25-dihydroxyvitamin D (25(OH)D) levels, together or separately, are indicators of the risk of stroke. Materials and Methods. This prospective study was performed at two centers. In the study, 100 patients diagnosed with acute ischemic stroke and 100 control individuals in the same age range were examined. In addition to neurological examination, cranial imaging, extensive routine blood chemistry, PTH, and 25(OH)D levels were evaluated in all cases. Stroke risk factors were determined. Logistic regression was used for statistical analysis. Results. A total of 60 patients and 79 control individuals were included in the study. Different estimation models were designed in order to examine the relationship between PTH and 25(OH)D levels with stroke. According to modeling results, it was determined that the most effective predictor for risk of stroke was 25(OH)D levels, followed by hypertension and PTH levels, respectively. Conclusion. PTH and 25(OH)D levels together can make important contributions to determination of stroke risk, and further investigations are needed to understand this relationship more fully.

Abstract P612: Iron Deficiency Anemia and Ischemic Stroke in Patients With Pulmonary Arteriovenous Fistulas

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Karan Topiwala ◽  
Smit Patel ◽  
Mubashir Pervez ◽  
Claire Shovlin ◽  
Mark J Alberts
Keyword(s):  
Ischemic Stroke ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Stroke Risk ◽  
Paradoxical Embolism ◽  
Deficiency Anemia ◽  
Risk Markers ◽  
Arteriovenous Fistulas ◽  
Stroke Risk Factors ◽  
Pulmonary Arteriovenous Fistulas

Introduction: Pulmonary-arteriovenous-fistulas (PAVFs) are pathologic right-to-left shunts resulting in paradoxical embolism causing acute-ischemic-stroke (AIS). Recent single-center studies have identified that in patients with AIS associated with PAVF (AIS-P), traditional stroke risk-factors are not prominent and instead stroke-risk is associated with low serum iron. Single-centre studies have the risk of introducing a selection bias, while multicentre trials are challenging since PAVF still remains a rare and under-recognised entity. We thus seek epidemiological validation of such stroke predictors in patients with PAVF. Methods: We conducted a retrospective analysis of all AIS-admissions within the Nationwide-Inpatient-Sample (NIS) database (2005-2014). Baseline characteristics were compared across AIS populations [AIS-P (with PAVF) and R(routine)-AIS (without PAVF)]. We also compared morbidity, mortality and management trends of AIS in patients with and without PAVF. Results: Of 4,271,910 patients admitted with AIS, 822 (0.02%) were diagnosed with a PAVF. Over this decade the prevalence of PAVF per million AIS-admissions, rose from 197 to 368 (P trend =0.026). Patients with PAVF were younger with a median age (IQR) of 57.5 (42.2 -70.4) years vs. 72.5 (60.8-82.1) years (p<0.001); but had comparable age-adjusted inpatient morbidity (χ 2 p=0.71) and all-cause mortality (χ 2 p=0.26). On multivariate analyses, the odds ratios (95% confidence-interval) favouring PAVF as the cause for AIS were 9.0 (6.79-11.94) for hypoxemia, 4.64 (3.84-5.60) for patent-foramen-ovale, 4.52 (3.42-5.97) for pulmonary hypertension, 4.07(2.23-7.44) for epistaxis, and 2.12 (1.60-2.82) for iron deficiency anaemia [all p-values <0.001]. Conclusion: Pulmonary-arteriovenous-fistula related AIS represents a significantly younger demographic, which suffers inpatient morbidity and mortality comparable to routine ischemic-stroke. They carry a unique set of stroke-risk markers, including treatable conditions such as iron deficiency anemia. Further studies are needed to examine a causal role for such markers on ischemic-stroke risk in this cohort.

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