scholarly journals Effect of A Randomized trial of Unruptured Brain Arteriovenous Malformation on Interventional Treatment Rates for Unruptured Arteriovenous Malformations

2019 ◽  
Vol 47 (5-6) ◽  
pp. 299-302 ◽  
Author(s):  
Alexandra S. Reynolds ◽  
Monica L. Chen ◽  
Alexander E. Merkler ◽  
Abhinaba Chatterjee ◽  
Iván Díaz ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Arteriovenous Malformations ◽  
Population Level ◽  
International Classification Of Diseases ◽  
Interventional Treatment ◽  
Classification Of Diseases ◽  
Nationally Representative ◽  
Brain Avms ◽  
Join Point ◽  
Procedure Codes

Background: In 2013, investigators from A Randomized Trial of Unruptured Brain Arteriovenous Malformations (AVM; ARUBA) reported that interventions to obliterate unruptured AVMs caused more morbidity and mortality than medical management. Objective: We sought to determine whether interventions for unruptured AVM decreased after publication of ARUBA results. Methods: We used the Nationwide Readmissions Database to assess trends in interventional AVM management in patients ≥18 years of age from 2010 through 2015. Unruptured brain AVMs were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 747.81 and excluding any patient with a diagnosis of intracranial hemorrhage. Our primary outcome was interventional AVM treatment, identified using ICD-9-CM procedure codes for surgical resection, endovascular therapy, and stereotactic radiosurgery. Join-point regression was used to assess trends in the incidence of interventional AVM management among adults from 2010 through 2015. Results: There was no significant U.S. population level change in unruptured brain AVM intervention rates before versus after ARUBA (p = 0.59), with the incidence of AVM intervention ranging from 8.0 to 9.2 per 10 million U.S. residents before the trial publication to 7.7–8.3 per 10 million afterwards. Conclusions: In a nationally representative sample, we found no change in rates of interventional unruptured AVM management after publication of the ARUBA trial results.

scholarly journals Quantifying Emergency Department Visits From Sport and Recreation: Focus on the Lower Extremity and Knee, 1997–2009

2016 ◽  
Vol 51 (4) ◽  
pp. 309-316 ◽  
Author(s):  
Matthew S. Tenan
Keyword(s):  
Emergency Department ◽  
Lower Extremity ◽  
Population Level ◽  
International Classification Of Diseases ◽  
Emergency Department Visits ◽  
Sample Survey ◽  
Ed Visits ◽  
Nationally Representative ◽  
Sport And Recreation

Few authors have reported nationally representative data on the number of sport and recreation (SR) injuries resulting in emergency department (ED) visitation. The existing studies have only provided 1 or 2 years of data and are not longitudinal in nature.Context: To use a novel algorithmic approach to determine if ED visitation is due to SR, resulting in a substantially larger longitudinal dataset.Objective: Descriptive epidemiology study.Design: Hospital.Setting: The National Hospital Ambulatory Medical Care Survey, a stratified random-sample survey of US hospital EDs was combined for years 1997–2009. There were 15 699 unweighted patient visits determined to be from SR.Patients or Other Participants: A custom algorithm classified SR visits based on the International Classification of Diseases, Ninth Revision, Clinical Modification E-code and pattern recognition of narrative text. Sport and recreation visits were assessed by age and categorized according to broad injury classifications. Additional quantification was performed on SR visits for lower extremity and knee-specific injuries. Sample weights were applied to provide national annual estimates.Main Outcome Measure(s): Annually, 4 243 000 ED visits resulted from SR. The largest classification of injury from SR was sprains and strains (896 000/y). Males had substantially more SR-related ED visits than females (2 929 000/y versus 1 314 000/y). For patients 10–49 years old, 1 093 000 lower extremity and 169 000 knee-specific injury visits annually were from SR. For both injury types, males had a higher rate of ED visitation; however, females had 25% and 39% greater odds of visitation for lower extremity and knee-specific injury, respectively.Results: The burden on the health system of ED visits from SR was substantial. Males presented in the ED at a higher rate for SR injury, though females had a higher proportion of lower extremity and knee-specific injury ED visitations from SR. This longitudinal analysis of population-level data provides the information to target research on specific subpopulations to mitigate SR injury.Conclusions:

scholarly journals Modern Look at Transverse Myelitis and Inflammatory Myelopathy

2021 ◽  
Vol 8 (6) ◽  
pp. e1071
Author(s):  
Justin R. Abbatemarco ◽  
Jonathan R. Galli ◽  
Michael L. Sweeney ◽  
Noel G. Carlson ◽  
Verena C. Samara ◽  
...  
Keyword(s):  
Transverse Myelitis ◽  
Population Level ◽  
International Classification Of Diseases ◽  
Mortality Data ◽  
Veterans Health ◽  
Health Administration ◽  
Level Data ◽  
High Prevalence ◽  
Classification Of Diseases

Background and ObjectivesTo characterize population-level data associated with transverse myelitis (TM) within the US Veterans Health Administration (VHA).MethodsThis retrospective review used VHA electronic medical record from 1999 to 2015. We analyzed prevalence, disease characteristics, modified Rankin Scale (mRS) scores, and mortality data in patients with TM based on the 2002 Diagnostic Criteria.ResultsWe identified 4,084 patients with an International Classification of Diseases (ICD) code consistent with TM and confirmed the diagnosis in 1,001 individuals (90.7% males, median age 64.2, 67.7% Caucasian, and 31.4% smokers). The point prevalence was 7.86 cases per 100,000 people. Less than half of the cohort underwent a lumbar puncture, whereas only 31.8% had a final, disease-associated TM diagnosis. The median mRS score at symptom onset was 3 (interquartile range 2–4), which remained unchanged at follow-up, although less than half (43.2%) of the patients received corticosteroids, IVIg, or plasma exchange. Approximately one-quarter of patients (24.3%) had longitudinal extensive TM, which was associated with poorer outcomes (p = 0.002). A total of 108 patients (10.8%) died during our review (94.4% males, median age 66.5%, and 70.4% Caucasian). Mortality was associated with a higher mRS score at follow-up (OR 1.94, 95% CI, 1.57–2.40) and tobacco use (OR 1.87, 95% CI, 1.17–2.99).DiscussionThis national TM review highlights the relatively high prevalence of TM in a modern cohort. It also underscores the importance of a precise and thorough workup in this disabling disorder to ensure diagnostic precision and ensure optimal management for patients with TM in the future.

scholarly journals Use of Medicare Diagnosis and Procedure Codes to Improve Detection of Surgical Site Infections following Hip Arthroplasty, Knee Arthroplasty, and Vascular Surgery

2012 ◽  
Vol 33 (1) ◽  
pp. 40-49 ◽  
Author(s):  
Michael S. Calderwood ◽  
Allen Ma ◽  
Yosef M. Khan ◽  
Margaret A. Olsen ◽  
Dale W. Bratzler ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Site Infections ◽  
Fold Increase ◽  
International Classification Of Diseases ◽  
Medicare Claims ◽  
Classification Of Diseases ◽  
Control And Prevention ◽  
Procedure Codes

Objective.To evaluate the use of routinely collected electronic health data in Medicare claims to identify surgical site infections (SSIs) following hip arthroplasty, knee arthroplasty, and vascular surgery.Design.Retrospective cohort study.Setting.Four academic hospitals that perform prospective SSI surveillance.Methods.We developed lists of International Classification of Diseases, Ninth Revision, and Current Procedural Terminology diagnosis and procedure codes to identify potential SSIs. We then screened for these codes in Medicare claims submitted by each hospital on patients older than 65 years of age who had undergone 1 of the study procedures during 2007. Each site reviewed medical records of patients identified by either claims codes or traditional infection control surveillance to confirm SSI using Centers for Disease Control and Prevention/ National Healthcare Safety Network criteria. We assessed the performance of both methods against all chart-confirmed SSIs identified by either method.Results.Claims-based surveillance detected 1.8–4.7-fold more SSIs than traditional surveillance, including detection of all previously identified cases. For hip and vascular surgery, there was a 5-fold and 1.6-fold increase in detection of deep and organ/space infections, respectively, with no increased detection of deep and organ/space infections following knee surgery. Use of claims to trigger chart review led to confirmation of SSI in 1 out of 3 charts for hip arthroplasty, 1 out of 5 charts for knee arthroplasty, and 1 out of 2 charts for vascular surgery.Conclusion.Claims-based SSI surveillance markedly increased the number of SSIs detected following hip arthroplasty, knee arthroplasty, and vascular surgery. It deserves consideration as a more effective approach to target chart reviews for identifying SSIs.Infect Control Hosp Epidemiol 2012;33(1):40-49

Deaths with Dementia in Indigenous and Non-Indigenous Australians: A Nationwide Study

2021 ◽  
pp. 1-11
Author(s):  
Michael Waller ◽  
Rachel F. Buckley ◽  
Colin L. Masters ◽  
Francis R. Nona ◽  
Sandra Eades ◽  
...  
Keyword(s):  
Death Certificate ◽  
Relative Rate ◽  
Population Level ◽  
International Classification Of Diseases ◽  
Mortality Data ◽  
Indigenous Australians ◽  
Indigenous Status ◽  
Indigenous Group ◽  
Classification Of Diseases ◽  
Underlying Cause Of Death

Background: The prevalence of dementia is generally reported to be higher among Indigenous peoples. Objective: The rates and coding of dementia mortality were compared between Indigenous and non-Indigenous Australians. Methods: De-identified individual records on causes of death for all people aged 40 years or more who died in Australia between 2006 and 2014 (n = 1,233,084) were used. There were 185,237 records with International Classification of Diseases, Tenth Revision, codes for dementia (Alzheimer’s Disease, vascular dementia, or unspecified dementia) as the underlying cause of death or mentioned elsewhere on the death certificate. Death rates were compared using Poisson regression. Logistic regression was used to assess whether dementia was more likely to be classified as ‘unspecified’ type in Indigenous Australians. Results: The rates of death with dementia were 57% higher in Indigenous Australians, compared to non-Indigenous, relative rate (RR) 1.57, 95% confidence interval (CI) (1.48, 1.66), p <  0.0001. This excess of deaths was highest at ages below 75 (RRs >  2, test for interaction p <  0.0001), and among men (test for interaction p <  0.0001). When the underreporting of Indigenous status on the death certificate was taken into account the relative rate increased to 2.17, 95% CI (2.07, 2.29). Indigenous Australians were also more likely to have their dementia coded as ‘unspecified’ on their death certificate (Odds Ratio 1.92, 95% CI (1.66, 2.21), p <  0.0001), compared to the non-Indigenous group. Conclusion: This epidemiological analysis based on population level mortality data demonstrates the higher dementia-related mortality rate for Indigenous Australians especially at younger ages.

scholarly journals Improving the quality of care pathways for sarcoma patients and the advantages of using WCISU’s (Welsh Cancer Intelligence Surveillance Unit) national cancer registry

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Rowena Griffiths ◽  
Ashley Akbari ◽  
Dyfed Huws ◽  
Ronan Lyons ◽  
Martin Rolles ◽  
...  
Keyword(s):  
Cancer Registry ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Diagnosis And Treatment ◽  
Care Pathways ◽  
Hospital Data ◽  
National Cancer Registry ◽  
Classification Of Diseases ◽  
Procedure Codes

IntroductionSoft Tissue Sarcoma (STS) diagnosis is difficult due to its nature and the variability of its occurrence on the body. To improve patient outcomes a better understanding was needed of the care pathways experienced by the patient from initial presentation to final treatment. Objectives and ApproachSeveral items of information are necessary, within the data, to identify a care pathway. A correct STS diagnosis, a presentation date or first investigation date, a diagnosis date and any subsequent treatment dates. Identifying cases in hospital data, using International Classification of Diseases (ICD10) codes - C40, C41, C47 and C49 - based on cancer site - can miss cases and cause difficulties when trying to distinguish the difference between the investigation and treatment stages. Having access to WCISU’s national cancer registry, proved advantageous and enabled the routine data to be validated. ResultsAttempts to identify differences between investigative and treatment procedures using the procedure codes available in hospital data was unhelpful due to variations in coding. However, WCISU’s national cancer registry records all cases of cancer diagnosed in Wales using both ICD10 and International Classification of Diseases for Oncology codes to record cancer morphology. In addition, it records the date of diagnosis and treatment start dates. Using the cancer registry it was possible to cross-check the cases extracted from the hospital data and identify the diagnosis and treatment dates. By matching the treatment dates back to the hospital data it then became possible to analyse the procedure codes to see how many treatments were being delivered, the type of treatment and the periods covered. Conclusion/ImplicationsOnce accurate diagnosis and treatments dates were identified, it was possible to drill further into the hospital data to see the finer detail of the procedures the patient received. Utilising independent data sources made it possible to develop an enriched view of patient care pathways from diagnosis through to treatment.

Treatment Outcomes of A Randomized Trial of Unruptured Brain Arteriovenous Malformation-Eligible Unruptured Brain Arteriovenous Malformation Patients

Neurosurgery ◽  
2017 ◽  
Vol 83 (3) ◽  
pp. 548-555 ◽  
Author(s):  
Min Lang ◽  
Nina Z Moore ◽  
Peter A Rasmussen ◽  
Mark D Bain
Keyword(s):  
Arteriovenous Malformation ◽  
Randomized Trial ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Interventional Treatment ◽  
Brain Arteriovenous Malformation ◽  
Brain Arteriovenous Malformations ◽  
Number Of Patients ◽  
Overall Risk

Abstract BACKGROUND The guideline for treating unruptured brain arteriovenous malformations (ubAVMs) remains controversial. A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) reported lower risk of stroke or death with conservative management compared to interventional treatment. There were numerous limitations to the study, including short follow-up period and disproportionate number of patients treated with surgery and embolization. OBJECTIVE To evaluate whether treatment of ARUBA-eligible patients have acceptable outcomes at our institution. METHODS Retrospective analysis was performed on 673 patients with brain AVMs treated at our institution between 2001 and 2014. One hundred five patients were ARUBA eligible and included in the study. Patients were divided into the microsurgery or Gamma Knife Radiosurgery (GKS; Elekta, Stockholm, Sweden) arm depending on their final treatment. Mean follow-up period was 43 mo (range 4-136 mo). Primary outcome was stroke or death. RESULTS A total of 8 (7.6%) patients had a stroke or died. The overall risk of stroke or death was 11.4% (5 of 44 patients) for the microsurgery arm and 4.9% (3 of 61 patients) for the GKS arm. The annual rates of stroke or death were 2.1%, 4.0%, and 1.2% for the entire patient cohort, microsurgery arm, and GKS arm, respectively. AVM obliteration rates at the end of the follow-up period were 95.5% and 47.5% for the microsurgery and GKS arms, respectively. CONCLUSION We report a lower overall risk of stroke or death in our ARUBA-eligible patients following treatment than ARUBA. Our results suggest that microsurgery and GKS may be appropriate treatments for patients with ubAVM.

scholarly journals Incidence and Outcomes of Laryngeal Complications Following Adult Cardiac Surgery: A National Analysis

Dysphagia ◽  
2021 ◽  
Author(s):  
Arjun Verma ◽  
Joseph Hadaya ◽  
Zachary Tran ◽  
Vishal Dobaria ◽  
Josef Madrigal ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Artery Bypass ◽  
International Classification Of Diseases ◽  
Financial Outcomes ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Rising Incidence ◽  
Nationally Representative ◽  
National Analysis

AbstractLaryngeal complications (LCs) following cardiac operations contribute to increased morbidity and resource utilization. Using a nationally representative cohort of cardiac surgical patients, we characterized the incidence of LC as well as its associated clinical and financial outcomes. All adults undergoing coronary artery bypass grafting and/or valvular operations were identified using the 2010–2017 Nationwide Readmissions Database. International Classification of Diseases 9th and 10th Revision diagnosis codes were used to identify LC. Trends were analyzed using a rank-based, non-parametric test (nptrend). Multivariable linear and logistic regressions were used to evaluate risk factors for LC, and its impact on mortality, complications, resource use and 30-day non-elective readmissions. Of an estimated 2,319,628 patients, 1.7% were diagnosed with perioperative LC, with rising incidence from 1.5% in 2010 to 1.8% in 2017 (nptrend < 0.001). After adjustment, female sex [adjusted odds ratio 1.08, 95% confidence interval (CI) 1.04–1.12], advancing age, and multi-valve procedures (1.51, 95% CI 1.36–1.67, reference: isolated CABG) were associated with increased odds of LC. Despite no risk-adjusted effect on mortality, LC was associated with increased odds of pneumonia (2.88, 95% CI 2.72–3.04), tracheostomy (4.84, 95% CI 4.44–5.26), and readmission (1.32, 95% CI 1.26–1.39). In addition, LC was associated with a 7.7-day increment (95% CI 7.4–8.0) in hospitalization duration and $24,200 (95% CI 23,000–25,400) in attributable costs. The present study found LC to be associated with increased perioperative sequelae and resource utilization. The development and application of active screening protocols for post-surgical LC are warranted to increase early detection and reduce associated morbidity.

scholarly journals Understanding the full burden of drowning: a retrospective, cross-sectional analysis of fatal and non-fatal drowning in Australia

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e024868 ◽  
Author(s):  
Amy E Peden ◽  
Alison J Mahony ◽  
Paul D Barnsley ◽  
Justin Scarr
Keyword(s):  
Best Practice ◽  
Case Fatality ◽  
Population Level ◽  
International Classification Of Diseases ◽  
Cross Sectional ◽  
Life Saving ◽  
Classification Of Diseases ◽  
Icd Codes ◽  
Hospital Morbidity ◽  
Sectional Analysis

ObjectivesThe epidemiology of fatal drowning is increasingly understood. By contrast, there is relatively little population-level research on non-fatal drowning. This study compares data on fatal and non-fatal drowning in Australia, identifying differences in outcomes to guide identification of the best practice in minimising the lethality of exposure to drowning.DesignA subset of data on fatal unintentional drowning from the Royal Life Saving National Fatal Drowning Database was compared on a like-for-like basis to data on hospital separations sourced from the Australian Institute of Health and Welfare’s National Hospital Morbidity Database for the 13-year period 1 July 2002 to 30 June 2015. A restrictive definition was applied to the fatal drowning data to estimate the effect of the more narrow inclusion criteria for the non-fatal data (International Classification of Diseases (ICD) codes W65-74 and first reported cause only). Incidence and ratios of fatal to non-fatal drowning with univariate and Χ2 analysis are reported and used to calculate case-fatality rates.SettingAustralia, 1 July 2002 to 30 June 2015.ParticipantsUnintentional fatal drowning cases and cases of non-fatal drowning resulting in hospital separation.Results2272 fatalities and 6158 hospital separations occurred during the study period, a ratio of 1:2.71. Children 0–4 years (1:7.63) and swimming pools (1:4.35) recorded high fatal to non-fatal ratios, whereas drownings among people aged 65–74 years (1:0.92), 75+ years (1:0.87) and incidents in natural waterways (1:0.94) were more likely to be fatal.ConclusionsThis study highlights the extent of the drowning burden when non-fatal incidents are considered, although coding limitations remain. Documenting the full burden of drowning is vital to ensuring that the issue is fully understood and its prevention adequately resourced. Further research examining the severity of non-fatal drowning cases requiring hospitalisation and tracking outcomes of those discharged will provide a more complete picture.

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