scholarly journals The Epidemiology of Osteomyelitis in Children

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1000
Author(s):  
Nike Walter ◽  
Susanne Bärtl ◽  
Volker Alt ◽  
Markus Rupp
Keyword(s):  
Epidemiological Data ◽  
Incidence Rates ◽  
Treatment Protocols ◽  
Diagnosis Codes ◽  
Medical Institutions ◽  
Time Period ◽  
Appropriate Treatment ◽  
Icd 10 ◽  
Anatomical Localization ◽  
Group 5

Pediatric osteomyelitis remains challenging to treat. Detailed epidemiological data are required to estimate future developments. Therefore, we aimed to analyze how the incidence has changed over the last decade depending on age, gender, osteomyelitis subtype, and anatomical localization. Cases were quantified for patients aged 20 years or younger, using yearly reported ICD-10 diagnosis codes from German medical institutions for the time period 2009 to 2019. Incidence rates of osteomyelitis increased by 11.7% from 8.2 cases per 100,000 children in 2009 to 9.2 cases per 100,000 children in 2019. The age-specific incidence rate revealed the highest occurrence of osteomyelitis in patients aged 10–15 years (15.3/100,000 children), which increased by 23% over the observation period, followed by the age group 5–10 years (9.7/100,000 children). In 2019, out of all diagnoses, 39.2% were classified as acute, 38.4% as chronic, and 22.4% were unspecified, whereby chronic cases increased by 38.7%. The lower extremity was mainly affected, with 58.9% of osteomyelitis diagnoses in 2019. In conclusion, pediatric osteomyelitis is a serious issue, even in a developed and industrialized country such as Germany. Considering the recent incidence increase, the permanent need for appropriate treatment should let pediatricians and orthopedic surgeons deal with diagnosis and treatment protocols.

scholarly journals What is the burden of osteomyelitis in Germany? An analysis of inpatient data from 2008 through 2018

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nike Walter ◽  
Susanne Baertl ◽  
Volker Alt ◽  
Markus Rupp
Keyword(s):  
Trauma Surgery ◽  
Age Group ◽  
Diagnosis Codes ◽  
Medical Institutions ◽  
Interdisciplinary Approaches ◽  
Icd 10 ◽  
Anatomical Localization ◽  
Orthopedic And Trauma Surgery ◽  
Future Demands ◽  
Prevention Methods

Abstract Background The epidemiology of osteomyelitis in Germany is unknown, which makes it difficult to estimate future demands. Therefore, we aimed to analyse how the numbers of cases have developed over the last decade as a function of osteomyelitis subtype, age group, gender, and anatomical localization. Methods Osteomyelitis rates were quantified based on annual ICD-10 diagnosis codes from German medical institutions between 2008 through 2018, provided by the Federal Statistical Office of Germany (Destatis). Results Overall osteomyelitis prevalence increased by 10.44% from 15.5 to 16.7 cases per 100,000 inhabitants between 2008 through 2018. Out of 11,340 cases in 2018, 47.6% were diagnosed as chronic, 33.2% as acute and 19.2% as unspecified osteomyelitis. Men were often affected than women with 63.4% of all cases compared to 36.6%. The largest proportion of patients comprised the age group 60–69 years (22.1%), followed by 70–79 years (21.7%). A trend towards more osteomyelitis diagnoses in older patients was observed. Lower extremities were most frequently infected with 73.8% of all cases in 2018 (+ 10.8% change). Conclusions Osteomyelitis remains a serious problem for orthopedic and trauma surgery. Prevention methods and interdisciplinary approaches are strongly required.

scholarly journals Evaluation of DoD Syndrome Mapping and Baseline for ICD-9-CM to ICD-10-CM Transition

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Jessica Deerin ◽  
Jean-Paul Chretien ◽  
Paul Lewis
Keyword(s):  
Department Of Defense ◽  
Human Services ◽  
Military Health ◽  
Health And Human Services ◽  
Diagnostic Codes ◽  
Diagnosis Codes ◽  
Time Period ◽  
Icd 10 ◽  
Icd Codes ◽  
Number Of Visits

ObjectiveThe transition from ICD-9-CM to ICD-10-CM requires evaluationof syndrome mappings to obtain a baseline for syndromic surveillancepurposes. Two syndrome mappings are evaluated in this report.IntroductionThe Department of Defense conducts syndromic surveillanceof health encounter visits of Military Health System (MHS)beneficiaries. Providers within the MHS assign up to 10 diagnosiscodes to each health encounter visit. The diagnosis codes are groupedinto syndrome and sub-syndrome categories. On October 1, 2015,the Health and Human Services-mandated transition from ICD-9-CM to ICD-10-CM required evaluation of the syndrome mappingsto establish a baseline of syndrome rates within the DoD. The DoDdata within the BioSense system currently utilizes DoD ESSENCEsyndrome mappings. The Master Mapping Reference Table (MMRT)was developed by the CDC to translate diagnostic codes across theICD-9-CM and ICD-10-CM encoding systems to prepare for thetransition. The DoD ESSENCE and MMRT syndrome definitions arepresented in this analysis for comparison.MethodsDoD data was pulled from the BioSense Platform through aRStudio server on October 11, 2016, querying data from October1, 2014 to September 30, 2016. This time period provides twelvemonths of ICD-9-CM data and twelve months of ICD-10-CM data.The ICD codes were binned to both DoD ESSENCE syndromes andMMRT macro syndromes for comparison. Although a patient visitmay contain up to 10 ICD codes, only the first four were includedfor this analysis. Providers are trained to prioritize diagnosis codesby position. Only 2.2% of visits had greater than 4 diagnostic codes.Each ICD code in a visit is binned to an applicable syndrome. Thetotal number of visits includes visits that binned and did not bin toa syndrome. Multiple syndromes may be assigned to one patient’shealth encounter visit if multiple ICD codes are binned. Additionally,more than one code per visit may bin to the same syndrome; however,only unique syndromes are counted in the total syndrome rate. Thetotal syndrome rate was calculated by total unique syndrome visitsas the numerator and total number of visits during the ICD-9-CM orICD-10-CM time period as the denominator. The rates per 1000 totalvisits were calculated.ResultsAmong the DoD ESSENCE syndromes, the ICD-9-CM ratefor ILI was 36.3 per 1,000 compared to the ICD-10-CM rate of38.6 per 1,000. The ICD-9-CM rate for neurological was 18.1 per1,000 compared to the ICD-10-CM rate of 0.2 per 1,000.Among the MMRT syndromes, the ICD-9-CM rate for ILI was16.7 per 1,000 compared to the ICD-10-CM rate of 38.4 per 1,000.The ICD-9-CM rate for mental disorders was 73.8 per 1,000 comparedto the ICD-10-CM rate of 73.2 per 1,000.ConclusionsThis analysis provides baseline rates of MMRT syndromes andsub-syndromes for syndromic surveillance during the ICD-9-CM toICD-10-CM transition. These data will serve for future comparisonand tracking of syndrome-specific trends for military-relevant healththreats.

scholarly journals A Retrospective Review of the Contribution of Rare Diseases to Paediatric Mortality in Ireland

2020 ◽  
Author(s):  
Emer Anne Gunne ◽  
Cliona McGarvey ◽  
Karina Hamilton ◽  
Eileen Treacy ◽  
Deborah Lambert ◽  
...  
Keyword(s):  
Rare Diseases ◽  
Epidemiological Data ◽  
Healthcare Services ◽  
Incidence Rates ◽  
Hospital Death ◽  
Field Methods ◽  
Healthcare Planning ◽  
National Quality ◽  
Icd 10 ◽  
Irish Republic

Abstract Aims: To ascertain the number of paediatric deaths (0-14 years) with an underlying rare disease (RD) in the Irish Republic between the years 2006-2016, and to analyse bed usage by a paediatric cohort of RD inpatients prior to in-hospital death. Background: Rare Diseases are life-threatening or chronically debilitating diseases that affect fewer than 5 per 10,000 people in the EU. Although individually rare, collectively RDs are common, with a prevalence of 3.5-5.9% of the population. Under representation of RDs in hospital healthcare coding systems leads to a paucity of RD epidemiological data required for healthcare planning. Studies have cited variable incidence rates for RD, however the burden of RDs to healthcare services still remains unclear. This study represents a thorough effort to identify the percentage of child mortality and paediatric bed usage attributable to rare diseases in Ireland addressing a major gap in the RD field. Methods: Retrospective analysis of paediatric death registration details for the Irish Republic in the 11-year period 2006-2016 from the National Paediatric Mortality Register. Data was subcategorized as Neonatal (0-28 days), Post Neonatal (29 days < 1 year) and older (1-14 years). Bed usage data (ICD-10 code, narrative and usage) of paediatric inpatients who died during hospitalisation from January 2015 to December 2016 was extracted from the National Quality Assurance Intelligence System of in-patient data. Orphacodes were assigned to RD cases from narrative records of both datasets. Results: There were 4044 deaths registered from 2006-2016, aged <15yrs. 2368 (58.6%) had an underlying RD. Stratifying by age group; 55.6% (1140/2050) of neonatal deaths had an RD, 57.8% (450/778) post-neonatal, and 64% (778/1216) of children >1yr. Mortality coding using ICD-10 codes identified only 42% of RD cases with the remainder identified using death certificate narrative records. RD patients occupied 84% of bed days used by children <15 years discharged deceased in the analysis period January 2015 to December 2016. Conclusion: Additional routine RD coding is necessary to identify RDs within Irish healthcare systems to enable better healthcare planning. RD patients are overrepresented in paediatric mortality statistics and inpatient length of stay during hospital admission prior to death.

scholarly journals A Retrospective Review of the Contribution of Rare Diseases to Paediatric Mortality in Ireland

2020 ◽  
Author(s):  
Emer Anne Gunne ◽  
Cliona McGarvey ◽  
Karina Hamilton ◽  
Eileen Treacy ◽  
Deborah Lambert ◽  
...  
Keyword(s):  
Rare Diseases ◽  
Epidemiological Data ◽  
Healthcare Services ◽  
Incidence Rates ◽  
Hospital Death ◽  
Neonatal Deaths ◽  
Healthcare Planning ◽  
National Quality ◽  
Icd 10 ◽  
Irish Republic

Abstract Aims: To ascertain the number of paediatric deaths (0-14 years) with an underlying rare disease (RD) in the Irish Republic between the years 2006-2016, and to analyse bed usage by a paediatric cohort of RD inpatients prior to in-hospital death.Background: Rare diseases are often chronically debilitating and sometimes life-threatening diseases, affecting fewer than 5 per 10,000 people in the EU. Although individually rare, collectively RDs are common, with a prevalence of 3.5-5.9% of the population. Under-representation of RDs in hospital healthcare coding systems leads to a paucity of RD epidemiological data required for healthcare planning. Studies have cited variable incidence rates for RD, however the burden of RDs to healthcare services still remains unclear. This study represents a thorough effort to identify the percentage of child mortality and paediatric bed usage attributable to rare diseases in Ireland addressing a major gap in the RD field.Methods: Retrospective analysis of paediatric death registration details for the Irish Republic in the 11-year period 2006-2016 from the National Paediatric Mortality Register. Data was subcategorised as Neonatal (0-28 days), Post Neonatal (29 days < 1 year) and older (1-14 years). Bed usage data (ICD-10 code, narrative and usage) of paediatric inpatients who died during hospitalisation from January 2015 to December 2016 was extracted from the National Quality Assurance Intelligence System of in-patient data. Orphacodes were assigned to RD cases from narrative records of both datasets.Results: There were 4044 deaths registered from 2006-2016, aged <15yrs, of these 2368 (58.6%) had an underlying RD. Stratifying by age group; 55.6% (1140/2050) of neonatal deaths had an RD, 57.8% (450/778) post-neonatal, and 64% (778/1216) of children >1yr. Mortality coding using ICD-10 codes identified 42% of RD cases with the remainder identified using death certificate narrative records. RD patients occupied 87% of bed days used by children <15 years who died during hospitalisation from January 2015 to December 2016.Conclusion: Additional routine RD coding is necessary to identify RDs within Irish healthcare systems to enable better healthcare planning. RD patients are overrepresented in paediatric mortality statistics and inpatient length of stay during hospital admission prior to death.

scholarly journals Epidemiological and clinical characteristics of immunocompromised patients infected with Pneumocystis jirovecii in a twelve-year retrospective study from Norway

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stine Grønseth ◽  
Tormod Rogne ◽  
Raisa Hannula ◽  
Bjørn Olav Åsvold ◽  
Jan Egil Afset ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Fold Increase ◽  
Epidemiological Data ◽  
Opportunistic Pathogen ◽  
Incidence Rates ◽  
Clinical Findings ◽  
Pneumocystis Jirovecii ◽  
Common Denominator ◽  
Study Population ◽  
Cardinal Symptoms

Abstract Background Pneumocystis pneumonia (PCP) severely menaces modern chemotherapy and immunosuppression. Detailed description of the epidemiology of Pneumocystis jirovecii today is needed to identify candidates for PCP-prophylaxis. Methods We performed a 12-year retrospective study of patients with P. jirovecii detected by polymerase chain reaction in Central Norway. In total, 297 patients were included. Comprehensive biological, clinical and epidemiological data were abstracted from patients’ medical records. Regional incidence rates and testing trends were also assessed. Results From 2007 to 2017 we found a 3.3-fold increase in testing for P. jirovecii accompanied by a 1.8-fold increase in positive results. Simultaneously, regional incidence rates doubled from 5.0 cases per 100,000 person years to 10.8. A majority of the study population had predisposing conditions other than human immunodeficiency virus (HIV). Hematological (36.0%) and solid cancers (25.3%) dominated. Preceding corticosteroids were a common denominator for 72.1%. Most patients (74.4%) presented with at least two cardinal symptoms; cough, dyspnea or fever. Main clinical findings were hypoxia, cytopenias and radiological features consistent with PCP. A total of 88 (29.6%) patients required intensive care and 121 (40.7%) suffered at least one complication. In-hospital mortality was 21.5%. Three patients (1.0%) had received prophylaxis. Conclusions P. jirovecii is re-emerging; likely due to increasing immunosuppressants use. This opportunistic pathogen threatens the life of heterogenous non-HIV immunosuppressed populations currently at growth. Corticosteroids seem to be a major risk factor. A strategy to increase prophylaxis is called for.

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

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.

Doubling Recruitment of Pediatric Low-grade Glioma within Two Decades does not change Outcome – Report from the German LGG Studies

2021 ◽  
Vol 233 (03) ◽  
pp. 107-122
Author(s):  
Astrid Katharina Gnekow ◽  
Daniela Kandels ◽  
Torsten Pietsch ◽  
Brigitte Bison ◽  
Monika Warmuth-Metz ◽  
...  
Keyword(s):  
Standard Of Care ◽  
Incidence Rates ◽  
Observation Time ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Similar Distribution ◽  
Multicenter Studies ◽  
Histologic Diagnosis ◽  
Treatment Protocols ◽  
Therapy Algorithm

Abstract Background Successive multicenter studies for pediatric low-grade glioma (LGG) in Germany were accompanied by a doubling of annual recruitment over 2 decades. We investigated whether this increase conveyed a change of epidemiologic characteristics or survival. Methods and results Participating centers reported 4634 patients with the radiologic/histologic diagnosis of LGG (1996–2018), rising from 109 to 278/year. Relating these numbers to all pediatric CNS tumors registered at the German Childhood Cancer Registry, the LGG fraction and annual crude incidence rates increased (32% to 51%; 0.94 to 2.12/100,000 children/adolescents<15 years). The consecutive LGG studies recruited 899 (HIT-LGG 1996), 1592 (SIOP-LGG 2004), and 1836 (LGG-registry) patients with similar distribution of tumor-sites, histology, and dissemination. 5-year overall survival was 96%-98% at median observation time of 8.1 years. Acknowledging unequal follow-up periods, 589/899 (66%), 1089/1582 (69%), and 1387/1836 (76%) patients remained under observation, while 1252/4317 received adjuvant treatment with decreasing frequency of front-line radiotherapy from 16% to 5%. Conclusion Pediatric LGG incidence rates in Germany are now comparable to other European countries. The rise in patient numbers followed implementation of standard-of-care treatment protocols, but did not result in relevant changes of epidemiologic or clinical parameters or survival. Shifts in patient distribution between treatment arms reflect growing acceptance of the LGG therapy algorithm.

Abstract P625: Rate of Hemorrhagic Transformation After Ischemic Stroke and Associated Risk Factors: The Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS)

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Robert J Stanton ◽  
Eleni Antzoulatos ◽  
Elisheva R Coleman ◽  
Felipe De Los Rios La Rosa ◽  
Stacie L Demel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Case Fatality ◽  
Population Based ◽  
Hemorrhagic Transformation ◽  
Incidence Rates ◽  
Icd 10 ◽  
Potential Risk Factors ◽  
Adjusted Rate ◽  
Associated Risk Factors

Background: Hemorrhagic transformation (HT) of ischemic stroke can have devastating consequences, leading to longer hospitalizations, increased morbidity and mortality. We sought to identify the rate of HT in stroke patients not treated with tPA within a large, biracial population. Methods: The GCNKSS is a population-based stroke epidemiology study from five counties in the Greater Cincinnati region. During 2015, we captured all hospitalized strokes by screening ICD-9 codes 430-436 and ICD-10 codes I60-I68, and G45-46. Study nurses abstracted all potential cases and physicians adjudicated cases, including classifying the degree of HT. Patients treated with thrombolytics were excluded. Incidence rates per 100,000 and associated 95% confidence intervals (CI) were estimated for HT cases, age and sex adjusted to the 2000 US population. Multiple logistic regression was used to examine risk factors associated with HT. Results: In 2015, there were 2301 ischemic strokes included in the analysis. Of these 104 (4.5%) had HT; 23 (22.1%) symptomatic, 55 (52.9%) asymptomatic and 26 (25%) unknown. Documented reasons for not receiving tPA in these patients were: time (71, 68.3%), anticoagulant use (1, 1.0%), other (18,17.3%) and unknown (14, 13.5%), which were not significantly different compared to those without HT. Only 29/104 (18.3%) had HT classified as PH-1 or PH-2. The age, sex and race-adjusted rate of HT was 9.8 (7.9, 11.6) per 100,000. The table shows rates of potential risk factors and the adjusted odds of developing HT. 90 day all-cause case fatality for patients with HT was significantly higher, 27.9% vs. 15.7%, p<0.0001. Conclusion: We found that 4.5% of non-tPA treated IS patients had HT. These patients had more severe strokes, were more likely to have abnormal coagulation tests or anticoagulant use, and were more likely to die within 90 days. We also report the first population-based incidence rate of HT in non-tPA treated of 9.8/100,000, a rate similar to the incidence of SAH.

Dispersion in total cost of care for Medicare fee-for-service (FFS) patients with metastatic pancreatic cancer receiving FDA-approved/NCCN Category 1 regimens at 340B verus non-340B institutions.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18843-e18843
Author(s):  
Helen Latimer ◽  
Samantha Tomicki ◽  
Gabriela Dieguez ◽  
Paul Cockrum ◽  
George P. Kim
Keyword(s):  
Pancreatic Cancer ◽  
Cost Of Care ◽  
Metastatic Pancreatic Cancer ◽  
Fee For Service ◽  
Total Cost ◽  
Diagnosis Codes ◽  
Heavily Pretreated ◽  
Icd 10 ◽  
Liposomal Irinotecan ◽  
Line Of Therapy

e18843 Background: The Department of Health and Human Services (HHS) designed the 340B drug pricing program to allow institutions that service specialty populations to acquire drugs at lower prices. Objective: To analyze the dispersion in total cost of care (TCOC) for Medicare FFS patients (pts) with metastatic pancreatic cancer (m-PANC) treated at 340B or non-340B institutions, by NCCN Category 1 regimen. Methods: We identified pts with m-PANC using ICD-10 diagnosis codes in the 2016-18 Medicare Parts A/B/D 100% Research Identifiable Files. Study pts had 2+ claims with a pancreatic cancer diagnosis and Medicare FFS coverage for 6 months pre- and 3 months post-metastasis diagnosis. Study pts were treated with NCCN Category 1 regimens: 1L gemcitabine monotherapy (gem-mono), 1L gemcitabine/nab-paclitaxel (gem-nab), 1L FOLFIRINOX (FFX), and 2L liposomal irinotecan-based regimen (nal-IRI). Pts were attributed to 340B or non-340B institutions based on plurality of chemotherapy claims. TCOC reflects insurer-paid services per line of therapy (LOT) for 3 categories: chemotherapy/supportive drugs (chemo/Rx), inpatient care (IP), and other outpatient care (OP). We grouped pts by quartile (qrt) and evaluated drivers of TCOC and mean rates of admissions (admits/pt). Results: We identified 2,697 (340B) and 3,839 (non-340B) pts taking NCCN Category 1 regimens. Gem-mono represented 1% and 4% of all pts in 340B and non-340B institutions, respectively. Gem-nab accounted for 72% of pts in both cohorts. For gem-nab, FFX, and nal-IRI pts, median TCOC was similar in both cohorts, although mean TCOC by qrt was lower at 340B institutions than non-340B institutions, except for gem-nab in the 1st qrt. The components of TCOC were similar between 340B and non-340B institutions in all qrts. In both cohorts, % IP costs increased between the 1st and 4th qrt (340B:15% to 23%, non-340B:14% to 25%). From the 1st to the 4th qrt, admits/pt increased in both cohorts. In the 340B cohort, nal-IRI pts had the lowest admits/pt while gem-nab pts had the highest in all qrts. In the non-340B cohort, nal-IRI pts had the lowest admits/pt except for in the 1st qrt. Conclusions: Median TCOC was lower at 340B institutions than non-340B institutions for all regimens, and the range of TCOC dispersion was also smaller at 340B institutions. Across qrts, chemotherapy accounted for approximately half the TCOC; however, IP costs were proportionally higher in the 4th qrt. Comparing regimens, despite 2L nal-IRI pts being more heavily pretreated, median costs in each cohort were similar to 1L gem-nab and 1L FFX, while admits/pt were generally lower than 1L gem-nab and 1L FFX across qrts and cohorts.

Abstract P250: A Strategy for Reliable Identification of Ischemic Stroke, Thrombolytics, and Thrombectomy in Large Administrative Databases

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kori S Zachrison ◽  
Sijia Li ◽  
Mathew J Reeves ◽  
Opeolu M Adeoye ◽  
Carlos A Camargo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Administrative Data ◽  
Administrative Databases ◽  
Stroke Patients ◽  
Inpatient Hospitalization ◽  
Accurate Identification ◽  
Stroke Research ◽  
Diagnosis Codes ◽  
Icd 10 ◽  
Icd Codes

Background: Administrative data are frequently used in stroke research. Ensuring accurate identification of ischemic stroke patients, and those receiving thrombolysis and endovascular thrombectomy (EVT) is critical to ensure representativeness and generalizability. We examined differences in patient samples based on different modes of identification, and propose a strategy for future patient and procedure identification in large administrative databases. Methods: We used nonpublic administrative data from the state of California to identify all ischemic stroke patients discharged from an emergency department or inpatient hospitalization from 2010-2017 based on ICD-9 (2010-2015), ICD-10 (2015-2017), and MS-DRG discharge codes. We identified patients with interhospital transfers, patients receiving thrombolytics, and patients treated with EVT based on ICD, CPT and MS-DRG codes. We determined what proportion of these transfers and procedures would have been identified with ICD versus MS-DRG discharge codes. Results: Of 365,099 ischemic stroke encounters, most (87.7%) had both a stroke-related ICD-9 or ICD-10 code and stroke-related MS-DRG code; 12.3% had only an ICD-9 or ICD-10 code, and 0.02% had only a MS-DRG code. Nearly all transfers (99.9%) were identified using ICD codes. We identified32,433 thrombolytic-treated patients (8.9% of total) using ICD, CPT, and MS-DRG codes; the combination of ICD and CPT codes identified nearly all (98%). We identified 7,691 patients treated with EVT (2.1% of total) using ICD and MS-DRG codes; both MS-DRG and ICD-9/-10 codes were necessary because ICD codes alone missed 13.2% of EVTs. CPT codes only pertain to outpatient/ED patients and are not useful for EVT identification. Conclusions: ICD-9/-10 diagnosis codes capture nearly all ischemic stroke encounters and transfers, while the combination of ICD-9/-10 and CPT codes are adequate for identifying thrombolytic treatment in administrative datasets. However, MS-DRG codes are necessary in addition to ICD codes for identifying EVT, likely due to favorable reimbursement for EVT-related MS-DRG codes incentivizing accurate coding.

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