Abstract W MP75: Increase Usage of Acute Stroke Thrombolysis Leads to Better Outcome: The Emergency Medical Service-Discharge Diagnosis Data Linkage Analysis over Three Years

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Amanda Cotter ◽  
Khosrow Heidari ◽  
Michelle Androulakis ◽  
Andrea Griffin ◽  
Karen Cartrett ◽  
...  
Keyword(s):  
South Carolina ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Real Time ◽  
Hospital Discharge ◽  
Data Linkage ◽  
Discharge Diagnosis ◽  
Number Of Patients ◽  
Hospital Discharge Records ◽  
Stroke Thrombolysis

Background and Objective: South Carolina is located in the “buckle” of the stoke belt. Use of the emergency medical services (EMS), intravenous tissue plasminogen activator (IV t-PA) in acute stroke and its correlates, including outcomes have not been trended over time. To study the annual trends in the above acute stroke care parameters we linked the EMS database with the statewide hospital discharge records stored at South Carolina Department of Health and Environmental Control (SC DHEC). Methods: The ongoing statewide EMS database linkage with the hospital discharge records stored at SC DHEC, allow us to track EMS and acute stroke thrombolysis in real-time. Patients with a discharge diagnosis of ischemic stroke were included in the analysis. Patients transported via EMS were compared with patients not transported by EMS. Variables considered included patient demographics, stroke center status of the hospital, telemedicine usage and treatment with IV t-PA for the calendar years of 2010-2012. Results: In the calendar years of 2010-2012, 10,377; 10,532 and 10,900 hospitalized patients in SC were assigned a primary discharge diagnosis of ischemic stroke respectively. Of these, the number of patients transported by EMS that received IV t-PA (7.1%, 9.5% and 10.2%, in the years 2010-12; χ2 trend =15.3, p < 0.0001) shows a significant increasing linear trend over the number of patients that were not transported by EMS that received IV t-PA (2.5%, 3.6% and 3.7%, in the years 2010-12). Over the three years, patients that are treated with IV t-PA were more likely to be discharged home (39%, 42% and 49% in the years 2010-12 ) and less likely to be discharged to a healthcare institution or expire (61%, 58% and 51% in the years 2010-12; χ2 trend=9.3, p =0.002). Conclusion: Transportation by EMS increased the likelihood of receiving IV t-PA. Over three years, IV t-PA usage led to better outcome including increasing discharge to home, decreasing discharge to healthcare institution and death. The real-time data linkage methodology may allow us in future to test the impact of statewide interventions geared to promote the usage of EMS and IV t-PA.

Impact of atrial fibrillation on inpatient cost for ischemic stroke in the USA

2018 ◽  
Vol 14 (2) ◽  
pp. 159-166 ◽  
Author(s):  
Kumar Mukherjee ◽  
Khalid M Kamal
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Discharge ◽  
Significant Risk ◽  
Primary Diagnosis ◽  
Inpatient Cost ◽  
Targeted Interventions ◽  
Hospital Discharge Records ◽  
Hospital Characteristics

Background Atrial fibrillation is a significant risk factor for ischemic stroke and increases cost of treatment. Aims To estimate the incremental inpatient cost and length of stay due to atrial fibrillation among adults hospitalized with a primary diagnosis of ischemic stroke after controlling for sociodemographic, clinical, and hospital characteristics in a nationally representative discharge record of US population. Methods Hospital discharge records with a primary diagnosis of ischemic stroke were identified from the National Inpatient Sample data for the years 2010–2013. Generalized linear model with log link and least-square means were utilized to estimate the incremental inpatient cost and length of stay in ischemic stroke due to atrial fibrillation after controlling for sociodemographic, clinical, and hospital characteristics. Results Among 434,544 hospital discharge records with a primary diagnosis of ischemic stroke, 90,190 (20.76%) discharge records had a secondary diagnosis of atrial fibrillation. The average inpatient cost for all discharge records with a primary diagnosis of ischemic stroke was (mean = $13,072, median = $9270.87) significantly (p < 0.0001) higher compared to all discharge records without ischemic stroke (mean = $12,543.07, median = $7517.13). The mean length of stay for all records was 4.55 days (95% CI = 4.53–4.56). Among those identified with ischemic stroke, adjusted mean inpatient cost was higher by $2829 (95% CI = $2708–$2949) and mean length of stay was greater by 0.85 (95% CI = 0.81–0.89) for those with atrial fibrillation compared to those without. Conclusions The presence of atrial fibrillation was associated with increased inpatient cost and length of stay among patients diagnosed with ischemic stroke. Increased inpatient cost and length of stay call for a more comprehensive patient care approach including targeted interventions among adults diagnosed with ischemic stroke and atrial fibrillation, which could potentially reduce the overall cost in this population.

Abstract W P287: Does Comprehensive Stroke Certification Demonstrate a Significant Effect on Volume and Quality of Care?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Laurie Paletz ◽  
Shlee Song ◽  
Nili Steiner ◽  
Betty Robertson ◽  
Nicole Wolber ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Turnaround Time ◽  
Joint Commission ◽  
Stroke Patients ◽  
Number Of Patients ◽  
The Impact

Introduction/Background information: At the onset of acute stroke symptoms, speed, capability, safety and skill are essential-lost minutes can be the difference between full recoveries, poor outcome, or even death. The Joint Commission's Certificate of Distinction for Comprehensive Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care. While many hospitals have been surveyed, Cedars Sinai was the 5 th hospital in the nation to receive this certification. Researchable question: Does Comprehensive stroke certification (CSC) demonstrate a significant effect on volume and quality of care? Methods: We assembled a cross-functional, multidisciplinary expert team representing all departments and skill sets involved in treating stroke patients. We carefully screened eligible patients with acute ischemic stroke We assessed the number of patients treated at Cedars-Sinai with IV-T-pa t 6 months before and then 6 months after CSC and the quality of their care including medical treatment and door to needle time. Results: In the 6 months prior to Joint Commissions Stroke Certification we treated 20 of 395acute stroke patients with t-PA with an average CT turnaround time of 31±19minutes and an average Door to needle time (DTNT) of 68±32minutes. In the 6 months since Joint Commission Stroke Certification we have increased the number of acute stroke patients treated by almost double. There were 37 out of 489(P=0.02, Chi Square) patients treated with IV t-PA with an average CT turnaround time of 22±7minutes (p=0.08, t-test, compared to pre-CSC) and an average DTNT of 61± 23minutes (not different than pre-CSC). Conclusion: We conclude that Joint Commission Certification for stroke was associated with an increased rate of treatment with IV rt-PA in acute ischemic stroke patients. We were not able to document an effect on quality of care. Further studies of the impact of CSC certification are warranted.

Abstract P268: Community Wide Real-Time Stroke Code Capture to Better Identify Changes in Health Care Utilization During Covid-19

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Amelia Kenner Brininger ◽  
Lindsay L Olson-Mack ◽  
Lorraine Chmielowski ◽  
Kristi L Koenig ◽  
Mary A Kalafut ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Real Time ◽  
Healthcare Utilization ◽  
San Diego ◽  
San Diego County ◽  
Discharge Data ◽  
Stroke Incidence ◽  
Number Of Patients ◽  
Stroke Center ◽  
The Impact

Introduction: Many healthcare systems reported a decline in stroke admissions in the early months of the COVID-19 pandemic. We used real-time hospital admission data from Stroke Receiving Centers (SRCs) across San Diego County to quantify changes in stroke patients accessing healthcare with the onset of the COVID-19 pandemic. Rather than waiting for months-delayed discharge data, real-time stroke code data was used to understand the impact on healthcare utilization which may better inform mitigation strategies to encourage accessing care for acute stroke. Methods: We analyzed the total number of patients presenting to any of the 18 San Diego County SRCs for which a stroke code was activated between January 1, 2019 and July 31, 2020; and separated the times into: pre-pandemic (PP) as January 2019 thru February 2020, early-pandemic (EP) as March and April 2020, and mid-pandemic (MP) as May-July 2020. Patients arriving via emergency medical services or private transport were included. A public messaging campaign regarding the safety of accessing care for acute stroke started in early May 2020. Results: A total of 14,028 stroke codes were initiated between January 2019 and July 2020. An average of 43.2 stroke codes were activated per stroke center per month (range=39.6 to 46.7 activations per stroke center per month) during PP, 30.6 during EP and 37.7 during MP (p=.019). Overall, 30% fewer stroke code activations occurred during EP compared to the same months in the PP (p=.012). Mid-pandemic, there were 14.6% fewer stroke code activations compared to the same months pre-pandemic (p=.095). Conclusion: Stroke code activations decreased by 30% across San Diego County SRCs in the EP period compared to the previous year. It is unclear if this is primarily due to decreased healthcare utilization at the start of the COVID-19 pandemic or if there were changes in stroke incidence. MP showed stroke code activations increased compared to EP. This may be partially due to the public messaging campaign initiated after an analysis of PP to EP stroke code activations. We will continue to analyze stroke code data to better understand the impact of public messaging campaigns and determine when activations have returned to PP levels.

Abstract MP90: Validity of Hospital Discharge Diagnosis Codes for Stroke: Evaluation of New American Heart Association/American Stroke Association Definitions

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Sydney Jones ◽  
Rebecca F Gottesman ◽  
Eyal Shahar ◽  
Lisa Wruck ◽  
Wayne D Rosamond
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Ct Scan ◽  
Hospital Discharge ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Administrative Claims ◽  
Stroke Incidence ◽  
Study Sites

Background: Characterizing International Classification of Disease (ICD-9) code validity is essential given widespread use of hospital discharge and claims databases in research. Estimates for acute stroke vary depending on the codes investigated. We sought to estimate the validity of ICD-9 codes grouped according to the 2013 American Heart Association/ American Stroke Association (AHA/ASA) updated stoke definition and to explore differences by patient characteristics and study site. Methods: Medical records (N=4,260) containing ICD-9 codes 430-438 or stroke keywords in the discharge summary were abstracted for hospitalizations of Atherosclerosis Risk in Communities (ARIC) Study cohort members from 1987-2010. A computer algorithm and physician reviewer identified definite and probable ischemic stroke, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) with differences adjudicated by a second physician. Using ARIC diagnosis as a gold standard, we calculated the positive predictive value (PPV) and sensitivity of groups of ICD-9 codes matched to stroke subtypes by the AHA/ASA (ischemic stroke: 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91; ICH: 431; SAH: 430). We excluded codes for spinal and retinal infarcts (336.1, 362.31, 362.32), which were not validated in ARIC (N=3 events). Results: Thirty-three percent of 4,260 hospitalizations were validated as definite or probable strokes (1,251 ischemic, 120 ICH, 46 SAH), and 30% (1,276 of 4,260) of hospitalizations included ICD-9 codes identified by the AHA/ASA. The AHA/ASA code groups had PPV 76% and 68% sensitivity, compared to PPV 40% and 95% sensitivity for ICD-9 codes 430-438 (not 435) traditionally used to identify stroke. For ischemic stroke, AHA/ASA identified ICD-9 codes were present for 1,043 hospitalizations. Among these, PPV was 76% overall and was slightly higher for blacks (80%, N=400) compared to whites (74%, N=643; p=0.04). However, differences by race diminished conditional undergoing a CT scan or MRI (blacks 81%, N=390; whites 78%, N=601). Among whites, PPV for ischemic stroke ranged from 60-79%, and sensitivity ranged from 60-70% across study sites. ICD-9 codes 430-431 for ICH and SAH were present for 225 hospitalizations and had PPV 61%. PPV was higher among blacks (73%, N=89) compared to whites (53%, N=136; p=0.003), and differences by race were not diminished conditional on undergoing a CT scan or MRI. Among whites, PPV for ICH and SAH ranged from 38-60%, and sensitivity ranged from 78-89% across study sites. Conclusion: New AHA/ASA code groups had higher PPV but lower sensitivity for identifying acute stroke than a traditional code group. PPV was higher among blacks compared to whites and both PPV and sensitivity varied by study site. These data may be useful for calibrating estimates of stroke incidence generated from administrative claims data and in sensitivity analyses.

scholarly journals Telestroke in Northern Alberta: A Two Year Experience with Remote Hospitals

2010 ◽  
Vol 37 (6) ◽  
pp. 808-813 ◽  
Author(s):  
Khurshid Khan ◽  
Ashfaq Shuaib ◽  
Tammy Whittaker ◽  
Maher Saqqur ◽  
Thomas Jeerakathil ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Telephone Consultation ◽  
University Of Alberta ◽  
Number Of Patients ◽  
Local Physician ◽  
Video Link

AbstractBackground:Thrombolysis in acute ischemic stroke is usually performed in comprehensive stroke centres. Lack of stroke expertise in remote small hospitals may preclude thrombolysis. Telemedicine allows such management opportunities in distant hospitals.Methods:We report our experience in managing acute stroke over a two-year time period with telestroke. The University of Alberta Hospital acted as the ‘hub’ and seven remote hospitals as ‘spoke’. The neurologist at the ‘hub’ provided stroke expertise to the local physician using either a two-way video link or telephone. Cranial CT scans were transmitted to ‘hub’. Education sessions were held before the initiation of the program.Results:Of 210 patients 44 (21%) received thrombolysis at the ‘spoke’ sites. In 34/44 (77%) two-way video link was available while in 10/44 (23%) telephone was used. Five (11.4%) patients experienced intracranial hemorrhage after thrombolysis, 2 (4.5%) were symptomatic. Favorable (mRS=0-1) outcome at three months was 16/40 (40%) and mortality was 9/40 (22.5%). Four patients were lost to follow-up. There was no significant three months outcome difference between two-way video link and telephone consultation (P = 0.689). Over two years the number of acute stroke transfers decreased from 144 to 15 at one of the ‘spoke’ sites, a 92.5% decline.Conclusion:It is possible to successfully treat patients with acute ischemic stroke at remote sites through videoconferencing or telephone consultation. Telestroke can also lead to a significant reduction in the number of patients requiring transfer to a tertiary care centre.

Abstract 42: Epidemiological Surveillance of the Impact of the Covid-19 Pandemic on Stroke Care Using Artificial Intelligence

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Raul Nogueira ◽  
Jason Davies ◽  
Rishi Gupta ◽  
Ameer E Hassan ◽  
Thomas G Devlin ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Acute Stroke ◽  
Real Time ◽  
Systems Of Care ◽  
Stroke Care ◽  
Epidemiological Surveillance ◽  
Day Hospital ◽  
Stroke Patients ◽  
Number Of Patients ◽  
The Impact

Background: The degree to which the COVID-19 pandemic has affected systems of care, in particular those for time-sensitive conditions such as stroke, remains poorly quantified. We sought to evaluate the impact of COVID-19 in the overall screening for acute stroke utilizing a commercial clinical artificial intelligence (AI) platform. Methods: Data were derived from the Viz Platform, an AI application designed to optimize the workflow of acute stroke patients. Neuroimaging data on suspected stroke patients across 97 hospitals in 20 US states were collected in real-time and retrospectively analyzed with the number of patients undergoing imaging screening serving as a surrogate for the amount of stroke care. The main outcome measures were the number of CTA, CTP, Large vessel occlusions (LVOs) (defined according to the automated software detection), and severe strokes on CTP (defined as those with hypoperfusion volumes>70mL) normalized as number of patients per day per hospital. Data from the pre-pandemic (November 4, 2019 to February 29, 2020) and pandemic (March 1 to May 10, 2020) periods were compared at national and state levels. Correlations were made between the inter-period changes in imaging screening, stroke hospitalizations, and thrombectomy procedures using state-specific sampling. Results: A total of 23,223 patients were included. The incidence of LVO on CTA and severe strokes on CTP were 11.2%(n=2,602) and 14.7%(n=1,229/8,328), respectively. There were significant declines in the overall number of CTAs (-22.8%;1.39 to 1.07 patients/day/hospital,p<0.001) and CTPs (-26.1%;0.50 to 0.37 patients/day/hospital,p<0.001) as well as in the incidence of LVO (-17.1%;0.15 to 0.13 patients/day/hospital,p<0.001) and severe strokes on CTP (-16.7%;0.12 to 0.10 patients/day/hospital, p<0.005). The sampled cohort showed similar declines in the rates of LVOs versus thrombectomy (18.8%vs.19.5%, p=0.9) and CSC hospitalizations (18.8%vs.11.0%, p=0.4). Conclusions: A significant decline in stroke imaging screening has occurred during the COVID-19 pandemic. This underscores the broader application of AI neuroimaging platforms for the real-time monitoring of stroke systems of care.

Abstract 89: Accuracy and Clinical Implications of Cincinnati Pre-hospital Stroke Scale and Los Angeles Pre-hospital Stroke Scale use by Emergency Medical Services

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Tushar Trivedi ◽  
Khosrow Heidari ◽  
Anwar Merchant ◽  
Ed Jauch ◽  
Swamy Venkatesh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Los Angeles ◽  
Emergency Medical Services ◽  
Hospital Discharge ◽  
Predictive Value ◽  
False Negative ◽  
True Positive ◽  
Emergency Medical ◽  
Hospital Discharge Records ◽  
Iv Tpa

Background: Cincinnati Pre-hospital Stroke Scale (CPSS) and Los Angeles Pre-hospital Stroke Scale (LAPSS) are widely used by emergency medical services (EMS) to screen potential ischemic stroke patients. We performed a population based state-wide study to evaluate the accuracy of CPSS and LAPSS in identifying stroke cases and investigate their impact on ischemic stroke treatment. Methods: A statewide EMS database was created by linking South Carolina’s statewide Emergency Department (ED) and hospital discharge records for the calendar years 2010-2012. The EMS data were obtained from the Division of EMS and Trauma at Department of Health Environmental Control and linked to hospitalization records at Office of Research and Statistics. Results from the EMS use of CPSS and LAPSS were compared with hospital discharge diagnoses for stroke. For both scales, we calculated Sensitivity, Specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). Additionally we evaluated the impact of identification of stroke during EMS transportation by CPSS/LAPSS on treatment of ischemic stroke with intravenous tissue plasminogen activator (IV-tPA). Results: Of all the EMS transported cases between January 2010 and December 2012, use of CPSS or LAPSS was recorded for 101,442 cases. Among the cases where the use of CPSS/LAPSS stroke scale was recorded, 6,757 cases had a diagnosis of ischemic stroke on hospital discharge records. CPSS demonstrated sensitivity of 59%, and specificity of 96%. Sensitivity and specificity for LAPSS were 26% and 84%, respectively. PPV and NPV for CPSS were 45% and 98%, and for LAPSS were 27% and 83%, respectively. Rates of IV-tPA administration were approximately five times higher for those correctly identified by CPSS (18.3% for true positive vs. 3.5% for false negative, P<0.01), and about two higher for those correctly identified by LAPSS (33.3% for true positive vs. 14.9% for false negative, P<0.01). Conclusion: Early identification of potential stroke cases using CPSS/LAPSS can have a significant impact on treatment of ischemic stroke with IV-tPA. We report a modest accuracy of CPSS and LAPSS in correctly identifying stroke cases in the field, with CPSS leading to a better rate of IV-tPA use compared with LAPSS.

Anticoagulant therapy in practice

2012 ◽  
Vol 153 (19) ◽  
pp. 732-736
Author(s):  
Gergely Hofgárt ◽  
Csilla Vér ◽  
László Csiba
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Health Science ◽  
Science Centre ◽  
Improper Use ◽  
Current Guidelines

Atrial fibrillation is a risk factor for ischemic stroke. To prevent stroke oral anticoagulants can be administered. Old and new types of anticoagulants are available. Nowadays, old type, acenocumarol based anticoagulants are used preferentially in Hungary. Aim: The advantages and the disadvantages of anticoagulants are well known, but anticoagulants are underused in many cases. Method: The authors retrospectively examined how frequent atrial fibrillation was and whether the usage of anticoagulants in practice was in accordance with current guidelines among acute stroke cases admitted to the Department of Neurology, Medical and Health Science Centre of Debrecen University in 2009. Results: Of the 461 acute stroke cases, 96 patients had known and 22 patients had newly discovered atrial fibrillation. Half of the patients did not receive proper anticoagulation. Only 8.4% of them had their INR levels within the therapeutic range. Conclusions: The findings are similar to those reported in other studies. Many factors may contribute to the high proportion of improper use of anticoagulants, and further investigations are needed to determine these factors. In any case, elimination of these factors leading to a failure of anticoagulation may decrease the incidence of stroke. Orv. Hetil., 2012, 153, 732–736.

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