RCVS: Symptoms, Incidence, and Resource Utilization in a Population-Based US Cohort

Objective:To estimate the incidence of hospitalization for reversible cerebral vasoconstriction syndrome (RCVS), we identified RCVS-related hospital admissions across 11 U.S. states in 2016.Methods:We tested the validity of ICD-10 code I67.841 in 79 patients with hospital admissions for RCVS or other cerebrovascular diseases at one academic and one community hospital. After determining that this code had a sensitivity of 100% (95% CI, 82-100%) and a specificity of 90% (95% CI, 79-96%), we applied it to administrative data from the Healthcare Cost and Utilization Project on all ED visits and hospital admissions. Age- and sex-standardized RCVS incidence was calculated using census data. Descriptive statistics were used to analyze associated diagnoses.Results:Across 5,067,250 hospital admissions in our administrative data, we identified 222 patients with a discharge diagnosis of RCVS in 2016. The estimated annual age- and sex-standardized incidence of RCVS hospitalization was 2.7 (95% CI, 2.4-3.1) cases per million adults. Many patients had concomitant neurologic diagnoses, including subarachnoid hemorrhage (37%), ischemic stroke (16%), and intracerebral hemorrhage (10%). In the 90 days before the index admission, 97 patients had an ED visit and 34 patients a hospital admission, most commonly for neurologic, psychiatric, and pregnancy-related diagnoses. Following discharge from the RCVS hospital admission, 58 patients had an ED visit and 31 had a hospital admission, most commonly for neurologic diagnoses.Conclusions:Using population-wide data, we estimated the age- and sex-standardized incidence of hospitalization for RCVS in U.S. adults as approximately 3 per million per year.

Download Full-text

Changing patterns of hospital admission for asthma, 1981–97

Thorax ◽

10.1136/thx.56.9.687 ◽

2001 ◽

Vol 56 (9) ◽

pp. 687-690

Author(s):

D S Morrison ◽

P McLoone

Keyword(s):

Hospital Admission ◽

Hospital Admissions ◽

Admission Rate ◽

Hospital Admission Rate ◽

Admission Rates ◽

Lengths Of Stay ◽

Icd 10 ◽

Changing Patterns ◽

Bed Days ◽

Age And Sex

BACKGROUNDHospital admission rates for asthma have stopped rising in several countries. The aim of this study was to use linked hospital admission data to explore recent trends in asthma admissions in Scotland.METHODSLinked Scottish Morbidity Records (SMR1) for asthma (ICD-9 493 and ICD-10 J45–6) from 1981 to 1997 were used to describe rates of first admissions and readmissions by age and sex. As a measure of resource use, annual trends in bed days used were also explored by age and sex.RESULTSThere were 160 039 hospital admissions for asthma by 82 421 individuals in Scotland during the study period. The overall hospital admission rate increased by 122% (from 106.7 to 236.7 per 100 000 population) but this varied by sex, age, and admission type. First admissions rose by 70% from 73.2 per 100 000 in 1986 to 124.8 per 100 000 in 1997 while readmissions fell. Children (<15 years) experienced a decline in overall admissions after 1992 due to falls in both new admissions and readmissions. By 1997 the ratio of female to male admissions was 0.57 in children, but 1.50 above 14 years of age. Mean lengths of stay fell from 10.7 days to 3.7 days between 1981 and 1997 and bed days used showed little change except for a decline after 1992 in children.CONCLUSIONSAfter a period of increasing hospitalisation for asthma in Scotland, rates of admission among children have begun to fall but among adults admissions continue to rise.

Download Full-text

National record-linkage study of hospital admissions for schizophrenia in childhood and adolescence in England

European Child & Adolescent Psychiatry ◽

10.1007/s00787-021-01817-3 ◽

2021 ◽

Author(s):

Olena Seminog ◽

Uy Hoang ◽

Michael Goldacre ◽

Anthony James

Keyword(s):

Hospital Admissions ◽

Population Based ◽

Linkage Study ◽

Incidence Rates ◽

Childhood And Adolescence ◽

Childhood Onset ◽

Affective Psychosis ◽

Health Service Provision ◽

Childhood Onset Schizophrenia ◽

Icd 10

Abstract Background There is a lack of information on changes in hospital admission rates for childhood-onset schizophrenia (COS), or on patient characteristics, to inform clinical research and health service provision. Aims To report age- and sex-specific incidence rates of hospital admissions and day patient care for schizophrenia (ICD-10 F20) and non-affective psychosis (ICD-10 F20-29), by year of occurrence and age, in childhood and adolescence. Methods Population-based study using person-linked data for England (available 2001–2016); time-periods in single years and 4-year groups. Results Hospitalised incidence for schizophrenia increased with increasing age, from 0.03 (95% confidence interval (CI) 0.02–0.05) and 0.01 (0–0.01) per 100,000 in, respectively, males and females aged 5–12 years, to 3.67 (3.44–3.91) in males and 1.58 (1.43–1.75) in females aged 13–17 years. There was no gender difference in hospitalised incidence rates in children aged 5–12, but in 13–17 years old, there was a male excess. Rates for schizophrenia were stable over time in 5–12 years old. In ages 13–17, rates for schizophrenia decreased between 2001–2004 and 2013–2016 in males, from 6.65 (6.04–7.31) down to 1.40 (1.13–1.73), and in females from 2.42 (2.05–2.83) to 1.18 (0.92–1.48). The hospitalisation rates for schizophrenia and non-affective psychosis, combined, in 13–17 years old decreased in males from 14.20 (13.30–15.14) in 2001–2004 to 10.77 (9.97–11.60) in 2013–2016, but increased in females from 7.49 (6.83–8.20) to 10.16 (9.38–11.00). Conclusions The study confirms that childhood-onset schizophrenia is extremely rare, with only 32 cases identified over a 15-year period in the whole of England. The incidence of schizophrenia and non-affective psychosis increased substantially in adolescence; however, the marked reduction in the proportion of those diagnosed with schizophrenia in this age group suggests a possible change in diagnostic practice.

Download Full-text

Validation of a Case Definition for Pediatric Brain Injury Using Administrative Data

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.419 ◽

2017 ◽

Vol 44 (2) ◽

pp. 161-169 ◽

Cited By ~ 3

Author(s):

Jane McChesney-Corbeil ◽

Karen Barlow ◽

Hude Quan ◽

Guanmin Chen ◽

Samuel Wiebe ◽

...

Keyword(s):

Brain Injury ◽

Administrative Data ◽

Predictive Value ◽

External Validation ◽

Secondary Data ◽

Population Based ◽

Case Definition ◽

Case Definitions ◽

Icd 10 ◽

Pediatric Tbi

AbstractBackground: Health administrative data are a common population-based data source for traumatic brain injury (TBI) surveillance and research; however, before using these data for surveillance, it is important to develop a validated case definition. The objective of this study was to identify the optimal International Classification of Disease , edition 10 (ICD-10), case definition to ascertain children with TBI in emergency room (ER) or hospital administrative data. We tested multiple case definitions. Methods: Children who visited the ER were identified from the Regional Emergency Department Information System at Alberta Children’s Hospital. Secondary data were collected for children with trauma, musculoskeletal, or central nervous system complaints who visited the ER between October 5, 2005, and June 6, 2007. TBI status was determined based on chart review. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each case definition. Results: Of 6639 patients, 1343 had a TBI. The best case definition was, “1 hospital or 1 ER encounter coded with an ICD-10 code for TBI in 1 year” (sensitivity 69.8% [95% confidence interval (CI), 67.3-72.2], specificity 96.7% [95% CI, 96.2-97.2], PPV 84.2% [95% CI 82.0-86.3], NPV 92.7% [95% CI, 92.0-93.3]). The nonspecific code S09.9 identified >80% of TBI cases in our study. Conclusions: The optimal ICD-10–based case definition for pediatric TBI in this study is valid and should be considered for future pediatric TBI surveillance studies. However, external validation is recommended before use in other jurisdictions, particularly because it is plausible that a larger proportion of patients in our cohort had milder injuries.

Download Full-text

Emergency department use and hospital admission in children following ambulatory surgery: a retrospective population-based cohort study

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001188 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001188

Author(s):

Monakshi Sawhney ◽

Elizabeth G VanDenKerkhof ◽

David H Goldstein ◽

Xuejiao Wei ◽

Genevieve Pare ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Hospital Admission ◽

Hospital Admissions ◽

Ambulatory Surgery ◽

Day Surgery ◽

Population Based ◽

Administrative Database ◽

Same Day Discharge ◽

Ed Visits

IntroductionPaediatric ambulatory surgery (same day surgery and planned same day discharge) is more frequently being performed more in Canada and around the world; however, after surgery children may return to hospital, either through the emergency department (ED) or through a hospital admission (HA). The aim of this study was to determine the patient characteristics associated with ED visits and HA in the 3 days following paediatric ambulatory surgery.MethodsThis population-based retrospective cohort study used de-identified health administrative database housed at ICES and included residents of Ontario, younger than 18 years of age, who underwent ambulatory surgery between 2014 and 2018. Patients were not involved in the design of this study. The proportion of ED visit and HA were calculated for the total cohort, and the type of surgery. The ORs and 95% CIs were calculated for each outcome using logistic regression.Results83 468 children underwent select ambulatory surgeries. 2588 (3.1%) had an ED visit and 608 (0.7%) had a HA in the 3 days following surgery. The most common reasons for ED visits included pain (17.2%) and haemorrhage (10.5%). Reasons for HA included haemorrhage (24.8%), dehydration (21.9%), and pain (9.1%).ConclusionsOur findings suggest that pain, bleeding and dehydration symptoms are associated with a return visit to the hospital. Implementing approaches to prevent, identify and manage these symptoms may be helpful in reducing ED visits or hospital admissions.

Download Full-text

The Safety of Non-Transport Decisions Made by Ambulance Personnel: A Retrospective Study of Subsequent Hospital Admission and 30-Day Mortality

10.21203/rs.3.rs-276252/v1 ◽

2021 ◽

Author(s):

Kjersti Amundsen ◽

Marie Svanes Elden ◽

Lars Myrmel ◽

Jörg Assmus ◽

Audun Lange ◽

...

Keyword(s):

Retrospective Study ◽

Hospital Admission ◽

Hospital Admissions ◽

Information Age ◽

Time Of Day ◽

Ambulance Personnel ◽

Icd 10 ◽

Health Trust ◽

Reason For Admission ◽

Mental And Behavioral Disorders

Abstract BackgroundAmbulance missions do not always result in the patient being transported to a doctor or hospital after evaluation at the scene by ambulance personnel. Sometimes a patient is discharged at the scene but should have been transported for further examination and treatment. In this study, we aimed to identify and describe this group, and to investigate subsequent hospital admission within 72 hours and 30-day mortality, which may indicate the safety of leaving a patient at the scene after examination. MethodThis retrospective study was carried out in the Bergen health trust in western Norway and included ambulance missions from 2018. For each mission, we recorded the patient’s demographic information (age, gender, time of day), initial reason for contacting the emergency medical service (EMS), hospital admissions after non-transport, and time of death if within 30 days, in addition to some other variables. ResultsAmong 33,183 included acute and urgent ambulance missions, 7.3% of the patients were discharged at the scene after evaluation by ambulance personnel. The median age in this group was 47 years (IQR 28–70 years), compared to 64 years (IQR 39–80 years) for all included missions. Following a non-transport decision, 4.8% of the patients were admitted to a public hospital within 72 hours (median age, 59 years; IQR 35–76 years), with mental and behavioral disorders (ICD-10 chapter V) being the most common reason for admission (24.8%). The 30-day mortality rate following non-transport mission was 2.4%. In this group, the median age was 83 years (IQR 73–90 years), and the most common reasons for contacting EMS were breathing difficulties or lung diseases (25.4%), and injuries or fractures (18.6%). ConclusionOur present analysis revealed low rates of hospital admission within 72 hours, and 30-day mortality, among patients left at the scene following evaluation by ambulance personnel. These findings do not suggest an unsafe rate of non-transport in the Bergen EMS. There remains a need for further evaluation of the factors involved in the decision not to transport a patient, and the safety of these decisions.

Download Full-text

Examining the link between family health events and pupil performance in Wales

International Journal for Population Data Science ◽

10.23889/ijpds.v4i3.1217 ◽

2019 ◽

Vol 4 (3) ◽

Author(s):

Phil Murphy ◽

Samuel Brown

Keyword(s):

Educational Attainment ◽

Administrative Data ◽

Hospital Admissions ◽

Family Health ◽

Strong Relationship ◽

World Health ◽

Health Events ◽

Depth Analysis ◽

Icd 10 ◽

The Uk

Background with rationale There is evidence of a strong relationship between health (and mother’s health) and early educational attainment. With access to administrative data this relationship can be explored to greater depth for the UK. Main Aim To explore the effects of a pupil’s and their mother’s health (split into 22 categories) upon the pupil’s educational attainment through the use of administrative data. Methods/Approach Health events were found through hospital admissions and then converted into the World Health Organisation’s ICD-10 health events. Two year lags were also created for these health events. Probit and ordered probit analyses were then used to explore the effects of these health events on a binary pass/fail core subject indicator and on a teacher assessed grade for Maths, Science and English. Analysis was split by gender and keystage. Results Few of the health events affect the educational attainment of the pupil. The health of male pupils has little impact on education, with the mother’s health having a stronger impact. The mother’s past health events have the greatest impact upon the male pupil’s education. The male pupil’s past health effects keystage 2 pupils the most, with little effect for keystage 1 and 3 pupils. Female pupils’ health has little impact at keystage 1, with increasing importance at keystage 2 and 3. Mother’s health (including past health) seems to have the opposite effect, being more important at keystage 1 and less at keystage 2 and 3. The female pupil’s past health has a small but consistent impact across all keystages. Conclusion By splitting health into ICD-10 categories, the health events that affect education have been more clearly identified. Most importantly, however, is the contribution of administrative data, allowing for in-depth analysis of health on education.

Download Full-text

Visualisation and optimisation of alcohol-related hospital admissions ICD-10 codes in Welsh e-cohort data

International Journal for Population Data Science ◽

10.23889/ijpds.v6i1.1373 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Laszlo Trefan ◽

Ashley Akbari ◽

Jennifer Siân Morgan ◽

Daniel Mark Farewell ◽

David Fone ◽

...

Keyword(s):

Hospital Admission ◽

Hospital Admissions ◽

Accurate Determination ◽

Rate Sensitivity ◽

Misclassification Rate ◽

Care Utilization ◽

Diagnostic Codes ◽

Cohort Data ◽

Icd 10 ◽

Excessive Consumption

IntroductionThe excessive consumption of alcohol is detrimental to long term health and increases the likelihood of hospital admission. However, definitions of alcohol-related hospital admission vary, giving rise to uncertainty in the effect of alcohol on alcohol-related health care utilization. ObjectivesTo compare diagnostic codes on hospital admission and discharge and to determine the ideal combination of codes necessary for an accurate determination of alcohol-related hospital admission. MethodsRoutine population-linked e-cohort data were extracted from the Secure Anonymised Information Linkage (SAIL) Databank containing all alcohol-related hospital admissions (n,= 92,553) from 2006 to 2011 in Wales, United Kingdom. The distributions of the diagnostic codes recorded at admission and discharge were compared. By calculating a misclassification rate (sensitivity-like measure) the appropriate number of coding fields to examine for alcohol-codes was established. ResultsThere was agreement between admission and discharge codes. When more than ten coding fields were used the misclassification rate was less than 1%. ConclusionWith the data at present and alcohol-related codes used, codes recorded at admission and discharge can be used equivalently to identify alcohol-related admissions. The appropriate number of coding fields to examine was established: fewer than ten is likely to lead to under-reporting of alcohol-related admissions. The methods developed here can be applied to other medical conditions that can be described using a certain set of diagnostic codes, each of which can be a known sole cause of the condition and recorded in multiple positions in e-cohort data.

Download Full-text

Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England.

Wellcome Open Research ◽

10.12688/wellcomeopenres.15151.1 ◽

2019 ◽

Vol 4 ◽

pp. 49 ◽

Cited By ~ 17

Author(s):

Robert W Aldridge ◽

Dee Menezes ◽

Dan Lewer ◽

Michelle Cornes ◽

Hannah Evans ◽

...

Keyword(s):

Causes Of Death ◽

Hospital Admissions ◽

Social Deprivation ◽

Homeless People ◽

Population Based ◽

Cross Sectional Study ◽

Mortality Data ◽

Cross Sectional ◽

Icd 10 ◽

External Causes

Background: Homelessness has increased by 165% since 2010 in England, with evidence from many settings that those affected experience high levels of mortality. In this paper we examine the contribution of different causes of death to overall mortality in homeless people recently admitted to hospitals in England with specialist integrated homeless health and care (SIHHC) schemes. Methods: We undertook an analysis of linked hospital admission records and mortality data for people attending any one of 17 SIHHC schemes between 1st November 2013 and 30th November 2016. Our primary outcome was death, which we analysed in subgroups of 10th version international classification of disease (ICD-10) specific deaths; and deaths from amenable causes. We compared our results to a sample of people living in areas of high social deprivation (IMD5 group).Results: We collected data on 3,882 individual homeless hospital admissions that were linked to 600 deaths. The median age of death was 51.6 years (interquartile range 42.7-60.2) for SIHHC and 71.5 for the IMD5 (60.67-79.0). The top three underlying causes of death by ICD-10 chapter in the SIHHC group were external causes of death (21.7%; 130/600), cancer (19.0%; 114/600) and digestive disease (19.0%; 114/600). The percentage of deaths due to an amenable cause after age and sex weighting was 30.2% in the homeless SIHHC group (181/600) compared to 23.0% in the IMD5 group (578/2,512).Conclusion: Nearly one in three homeless deaths were due to causes amenable to timely and effective health care. The high burden of amenable deaths highlights the extreme health harms of homelessness and the need for greater emphasis on prevention of homelessness and early healthcare interventions.

Download Full-text

Gestational age and hospital admissions during childhood: population based, record linkage study in England (TIGAR study)

BMJ ◽

10.1136/bmj.m4075 ◽

2020 ◽

pp. m4075

Author(s):

Victoria Coathup ◽

Elaine Boyle ◽

Claire Carson ◽

Samantha Johnson ◽

Jennifer J Kurinzcuk ◽

...

Keyword(s):

Hospital Admission ◽

Gestational Age ◽

Record Linkage ◽

Hospital Admissions ◽

Population Based ◽

Admission Rates ◽

Adjusted Rate ◽

Gestational Age At Birth ◽

Adjusted Rate Ratio ◽

Age At Birth

AbstractObjectiveTo examine the association between gestational age at birth and hospital admissions to age 10 years and how admission rates change throughout childhood.DesignPopulation based, record linkage, cohort study in England.SettingNHS hospitals in England, United Kingdom.Participants1 018 136 live, singleton births in NHS hospitals in England between January 2005 and December 2006.Main outcome measuresPrimary outcome was all inpatient hospital admissions from birth to age 10, death, or study end (March 2015); secondary outcome was the main cause of admission, which was defined as the World Health Organization’s first international classification of diseases, version 10 (ICD-10) code within each hospital admission record.Results1 315 338 admissions occurred between 1 January 2005 and 31 March 2015, and 831 729 (63%) were emergency admissions. 525 039 (52%) of 1 018 136 children were admitted to hospital at least once during the study period. Hospital admissions during childhood were strongly associated with gestational age at birth (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, and 42 weeks). In comparison with children born at full term (40 weeks’ gestation), those born extremely preterm (<28 weeks) had the highest rate of hospital admission throughout childhood (adjusted rate ratio 4.92, 95% confidence interval 4.58 to 5.30). Even children born at 38 weeks had a higher rate of hospital admission throughout childhood (1.19, 1.16 to 1.22). The association between gestational age and hospital admission decreased with increasing age (interaction P<0.001). Children born earlier than 28 weeks had an adjusted rate ratio of 6.34 (95% confidence interval 5.80 to 6.85) at age less than 1 year, declining to 3.28 (2.82 to 3.82) at ages 7-10, in comparison with those born full term; whereas in children born at 38 weeks, the adjusted rate ratios were 1.29 (1.27 to 1.31) and 1.16 (1.13 to 1.19), during infancy and ages 7-10, respectively. Infection was the main cause of excess hospital admissions at all ages, but particularly during infancy. Respiratory and gastrointestinal conditions also accounted for a large proportion of admissions during the first two years of life.ConclusionsThe association between gestational age and hospital admission rates decreased with age, but an excess risk remained throughout childhood, even among children born at 38 and 39 weeks of gestation. Strategies aimed at the prevention and management of childhood infections should target children born preterm and those born a few weeks early.

Download Full-text

Risk of cardiovascular diseases after breast cancer: an analysis on a cohort of 1.3 million women

European Journal of Public Health ◽

10.1093/eurpub/ckz185.364 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

F Ricceri ◽

S C Calabrese ◽

E Ferracin ◽

D Di Cuonzo ◽

A Macciotta ◽

...

Keyword(s):

Breast Cancer ◽

Myocardial Infarction ◽

Census Data ◽

Hospital Admissions ◽

Cerebrovascular Diseases ◽

Breast Cancer Patients ◽

Cox Models ◽

Healthy Women ◽

Increased Risk ◽

Incident Cases

Abstract Background Breast cancer (BC) is the malignant tumor with the highest incidence in women in the world with an estimate of about 500,000 new cases per year in Europe. Guidelines for BC treatment include surgery followed by radiotherapy, hormonal therapy or chemotherapy. Several studies showed that BC treatment increases the risk of myocardial infarction (MI) while only few studies investigated the risk of stroke after BC. The aim of the present study was to assess the risk of MI and stroke in BC survivors, taking into account the possible influence of treatments. Methods Women included in the study are part of a longitudinal cohort including all residents in the Piedmont region linked to the 2011 census data and followed-up through administrative data on mortality, hospital admissions, drug prescriptions, and outpatient consultations. Validated algorithms to identify BC incident cases and their therapies as well as to identify MI and stroke were applied. The effect of BC on the risk of MI and stroke was tested using Cox models (adjusted for confounding variables) that allow to account for the competing risks. First, BC patients were compared to healthy women, then BC women that undertwent a specific therapy were compared with both healthy women and other BC patients. Results Women with BC showed an increased risk compared to healthy women for both MI (HR: 1.20; 95% CI: 1.05-1.38) and stroke (HR: 1.58; 95%CI: 1.38-1.82). Chemotherapy almost doubled the risk of MI, while radiotherapy did not seem to have a similar effect, even comparing with other BC patients. The high risk of stroke observed comparing BC (any therapy) with healthy women disappeared when comparing specific therapies among BC patients. Conclusions Chemotherapy increased the risk of MI in BC patients, while recent radiotherapy strategies had less impact, if any. Moreover, the mechanism for which BC patients have an increased risk of stroke seems not to be related to a late effect of therapies. Key messages Breast cancer women are at higher risk of developing cardio and cerebrovascular diseases and this should be taken into account when planning therapies and follow-up surveillance. Despite the increase in quality of the therapeutic approaches for breast cancer patients, chemotherapy increases the risk of myocardial infarction, while radiotherapy dangerousness recently decreased.

Download Full-text