Abstract T MP80: Comparison of ICD-9-CM and Clinical Diagnoses for Stroke Patients in the Paul Coverdell National Acute Stroke Registry, 2013

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Tiffany E Chang ◽  
Mary G George
Keyword(s):  
Acute Stroke ◽  
Performance Measures ◽  
Hemorrhagic Stroke ◽  
P Value ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Clinical Diagnoses ◽  
Improved Performance ◽  
Stroke Type ◽  
Ischemic Attack

Background: Few large studies have examined the comparison of ICD-9-CM codes and clinical diagnoses (CDX) for acute stroke patients. We analyzed the concordance between these two coding systems for patients entered in the Paul Coverdell National Acute Stroke Registry (PCNASR). We hypothesized that discordance between patient-level ICD-9-CM codes and clinical diagnoses will result in differences in outcomes on stroke performance measures (PMs). Methods: Eleven states submitted 90,035 records between Jan 1 and Dec 31, 2013. In-hospital strokes and records with multiple or missing CDXs were excluded from the analysis, resulting in a final sample size of 85,024. Clinical diagnoses were defined as: ischemic stroke (IS), transient ischemic attack (TIA), subarachnoid hemorrhagic stroke (SAH), intracerebral hemorrhagic stroke (ICH), stroke not specified (SNS), admission for carotid intervention only (CI), and other. Data was analyzed by comparing the documented principal ICD-9-CM code and final CDX of each patient. Any discordance between ICD-9-CM codes and CDX was analyzed further by examining its effect on outcomes of ten stroke performance measures (PMs) collected by PCNASR. Results: The agreement rate between ICD-9-CM codes and clinical diagnoses differs by stroke type (94.1% (IS) to 1.6% (SNS)) (Table 1). Discordance in diagnosis led to differences in outcomes on stroke PMs (range: difference of 0.1-1.03 percentage points; p-value < 0.05 for 5 measures), with 8 out of the 10 PMs having improved performance when ICD-9-CM codes are used (data not shown). Using only cases where the CDX is the same as the ICD-9-CM results in even higher adherence to PMs. Conclusion: In conclusion, due to discrepancies between ICD-9-CM codes and clinical diagnoses, outcomes on stroke PMs can vary significantly, depending on the diagnosis method used.

scholarly journals Accuracy of Administrative Data for the Coding of Acute Stroke and TIAs

2016 ◽  
Vol 43 (6) ◽  
pp. 765-773 ◽  
Author(s):  
Ruth Hall ◽  
Luke Mondor ◽  
Joan Porter ◽  
Jiming Fang ◽  
Moira K. Kapral
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Administrative Data ◽  
Data Validation ◽  
Reference Standard ◽  
Stroke Registry ◽  
Diagnostic Codes ◽  
Icd 10 ◽  
Stroke Type ◽  
Ischemic Attack

AbstractObjective: Administrative data validation is essential for identifying biases and misclassification in research. The objective of this study was to determine the accuracy of diagnostic codes for acute stroke and transient ischemic attack (TIA) using the Ontario Stroke Registry (OSR) as the reference standard. Methods: We identified stroke and TIA events in inpatient and emergency department (ED) administrative data from eight regional stroke centres in Ontario, Canada, from April of 2006 through March of 2008 using ICD–10–CA codes for subarachnoid haemorrhage (I60, excluding I60.8), intracerebral haemorrhage (I61), ischemic (H34.1 and I63, excluding I63.6), unable to determine stroke (I64), and TIA (H34.0 and G45, excluding G45.4). We linked administrative data to the Ontario Stroke Registry and calculated sensitivity and positive predictive value (PPV). Results:: We identified 5,270 inpatient and 4,411 ED events from the administrative data. Inpatient administrative data had an overall sensitivity of 82.2% (95% confidence interval [CI95%]=81.0, 83.3) and a PPV of 68.8% (CI95%=67.5, 70.0) for the diagnosis of stroke, with notable differences observed by stroke type. Sensitivity for ischemic stroke increased from 66.5 to 79.6% with inclusion of I64. The sensitivity and PPV of ED administrative data for diagnosis of stroke were 56.8% (CI95%=54.8, 58.7) and 59.1% (CI95%=57.1, 61.1), respectively. For all stroke types, accuracy was greater in the inpatient data than in the ED data. Conclusion: The accuracy of stroke identification based on administrative data from stroke centres may be improved by including I64 in ischemic stroke type, and by considering only inpatient data.

scholarly journals Early transition to comfort measures only in acute stroke patients

2017 ◽  
Vol 7 (3) ◽  
pp. 194-204 ◽  
Author(s):  
Shyam Prabhakaran ◽  
Margueritte Cox ◽  
Barbara Lytle ◽  
Phillip J. Schulte ◽  
Ying Xian ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Multivariable Analysis ◽  
Hospital Level ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Factors Associated ◽  
Early Decision ◽  
Stroke Type ◽  
Get With The Guidelines ◽  
Hospital Characteristics

AbstractBackground:Death after acute stroke often occurs after forgoing life-sustaining interventions. We sought to determine the patient and hospital characteristics associated with an early decision to transition to comfort measures only (CMO) after ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in the Get With The Guidelines–Stroke registry.Methods:We identified patients with IS, ICH, or SAH between November 2009 and September 2013 who met study criteria. Early CMO was defined as the withdrawal of life-sustaining treatments and interventions by hospital day 0 or 1. Using multivariable logistic regression, we identified patient and hospital factors associated with an early (by hospital day 0 or 1) CMO order.Results:Among 963,525 patients from 1,675 hospitals, 54,794 (5.6%) had an early CMO order (IS: 3.0%; ICH: 19.4%; SAH: 13.1%). Early CMO use varied widely by hospital (range 0.6%–37.6% overall) and declined over time (from 6.1% in 2009 to 5.4% in 2013; p < 0.001). In multivariable analysis, older age, female sex, white race, Medicaid and self-pay/no insurance, arrival by ambulance, arrival off-hours, baseline nonambulatory status, and stroke type were independently associated with early CMO use (vs no early CMO). The correlation between hospital-level risk-adjusted mortality and the use of early CMO was stronger for SAH (r = 0.52) and ICH (r = 0.50) than AIS (r = 0.15) patients.Conclusions:Early CMO was utilized in about 5% of stroke patients, being more common in ICH and SAH than IS. Early CMO use varies widely between hospitals and is influenced by patient and hospital characteristics.

scholarly journals Correlation of blood glucose levels, HbA1c, hemoglobin and leukocytes with outcome on acute stroke

2019 ◽  
Vol 7 (5) ◽  
pp. 1430
Author(s):  
Meiriani . ◽  
Yuneldi Anwar ◽  
Puji Pinta Omas Sinurat
Keyword(s):  
Ischemic Stroke ◽  
Blood Glucose ◽  
Acute Stroke ◽  
Hemorrhagic Stroke ◽  
Cross Sectional Study ◽  
P Value ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Glucose Levels ◽  
Blood Glucose Levels

Background: Diabetes and higher HbA1c level have increased the incidence of stroke. Hemoglobin levels both high and low are associated with poor outcomes. Leukocytes play an important role in the initiation of the atherosclerosis process.Methods: This was a cross-sectional study with a sample size of 62 people selected by non-random sampling method on a consecutive basis, patients with acute stroke were taken blood to measure blood glucose levels, HbA1c, Hb and Leucocytes when entering the hospital room. Outcomes were assessed using NIHSS and MRS. The calculation of NIHSS and MRS scores was performed on the first day of admission and the fourteenth day. To analyze the correlation of blood sugar levels during HbA1c, Hb and leukocytes in acute stroke, this study used Spearman's correlation test. The p value <0.05 was considered statistically significant.Results: The study subjects of 62 acute stroke patients (acute ischemic stroke 31 people and 31 people hemorrhagic stroke). Acute stroke patients were consisted of 38 men (61.3%) and 24 women (38.7%). Of 31 people with hemorrhagic stroke, there were 16 men (51.6%) and 15 women (48.4%), ischemic stroke patients were consisted of 22 people (71, 0%) and women were 9 people. Spearrman repair test showed no symptoms between blood glucose levels, HbA1c, Hemoglobin and leukocytes with outcomes in acute stroke.Conclusions: There was no significant association between blood glucose levels, HbA1c, hemoglobin and leukocytes with outcomes in acute stroke.

scholarly journals Why Stroke Patients Don’t Receive T-PA? An Analysis of Patient Eligibility: Implications for Improving Clinical Impact by Increasing Future Treatment Numbers

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 372-372
Author(s):  
Philip A Barber ◽  
Jinijin Zhang ◽  
Andrew M Demchuk ◽  
Michael D Hill ◽  
Andrea Cole-Haskayne ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Care ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Stroke Registry ◽  
Specific Protocol ◽  
Stroke Type ◽  
Ischemic Attack

P183 Background T-PA is an effective treatment of acute ischemic stroke within 3 hours. However, the success of t-PA on reducing disability is dependent on it being accessible to more patients. We identified the reasons why patients with ischemic stroke did not receive intravenous t-PA and assessed the community impact of the therapy in a large North American city. Methods Consecutive patients with acute ischemic stroke were identified in a prospective stroke registry at a teaching hospital between October 1996 and December 1999. Additional patients with ischemic stroke admitted to one of three other hospitals during the study period were identified. The Oxford Community Stroke Program Classification was used to record stroke type. Results Of 2165 stroke patients presenting to the emergency department 1179 (54.5%) were diagnosed with ischemic stroke, 31.7% with intracranial hemorrhage, and 13.8 % with transient ischemic attack. 84/339 (29%) patients were admitted within 3 hours of stroke received intravenous t-PA. The major reasons for exclusion for stroke patients presenting within 3 hours were mild stroke (20%), clinical improvement (18.6%), and specific protocol exclusions (11.5%). Delay in presentation to emergency department excluded 840/1179 (71%). 1817 ischemic stroke patients were admitted to Calgary hospitals during the study period of which 4.6% received intravenous t-PA. Generalization of the Calgary experience to other Canadian communities suggests the benefit from t-PA for ischemic stroke may be substantial with an additional 460 independent survivors per annum. Conclusion The effectiveness of t-PA can be improved by understanding why patients are excluded from its use. The eligibility of patients for t-PA must increase by promoting health education programs and by developing organized acute stroke care infrastructure within the community.

scholarly journals Serum Magnesium Level among the Patients Admitted with Acute Stroke in a Tertiary care Hospital

2018 ◽  
Vol 27 (1) ◽  
pp. 50-56
Author(s):  
Md Firoj Hossain ◽  
MN Hasan ◽  
SM Uddin ◽  
AA Masum ◽  
PM Basak
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Hemorrhagic Stroke ◽  
Serum Magnesium ◽  
Normal Serum ◽  
Magnesium Level ◽  
P Value ◽  
Serum Magnesium Level ◽  
Stroke Patients ◽  
The Mean

Magnesium deficiency was shown to trigger vasoconstriction and enhance vascular endothelial injury, thus promoting the development and progression of atherosclerosis. We hereby intended to investigate serum magnesium in the early stage of acute stroke and to evaluate the relationship between serum magnesium concentration and the development of neurological deficits. This is a descriptive type of cross sectional study was carried out in department of medicine, Comilla Medical College Hospital from June 2013 to December 2013. Fifty admitted acute stroke patients were randomly chosen for this study who fulfills inclusion criteria. The serum magnesium concentrations were measured by photometric colorimetric end point method on admission. Out of 50 acute stroke patients 30 (60%) were male and 20 (40%) were female. The mean age is 66.44 (SD ±14.8) years with male predominance. Most of the patients 30 (60%) belongs to above 60 years and 36 (72%) patients had hypomagnesaemia and 14 (28%) had normal serum magnesium level. Serum magnesium level more low in ischemic stroke (56%) . The mean serum magnesium level was 1.59 (SD ±0.37) mg/dl in all stroke patient and 1.47 (SD ±0.32) mg/dl in ischemic stroke patient was and was 1.83 (SD ±0.34) mg/dl in hemorrhagic stroke patients. Among 33 ischemic stroke patients mostly 17 (34%) patients had serum magnesium level between 1.0-1.4 mg/dl and in hemorrhagic stroke patients maximum 05 (10%) serum magnessium level was in between 1.5-1.8 mg/dl (P-value 0.0017 HS). In our study most of the patients with acute stroke were improved with marked residual disability were [19 (38.0%)], improved with minimal residual disability were [08 (16%)], improved without residual disability [04 (08%)] and death [03 (6%)] having hypomagnesaemia compared to the patients who have normal serum magnesium level with maximum improvement with minimal residual disability were [10 (20.0%)], improved without residual disability were [06 (12%)], improved with marked residual disability and death were [0 (0%)]. Gross clinical outcome disability of acute stroke patients was worse who had hypomagnesaemia (P-value 0.001 significant). Magnesium levels are significantly decreased in acute stroke; both in ischemic stroke patients as well as in patients of hemorrhagic. Patients with low serum magnesium level in acute stroke associated with worse clinical outcome.TAJ 2014; 27(1): 50-56

Continuous glucose monitoring in acute stroke

2019 ◽  
Author(s):  
Laura Aponte-Becerra ◽  
Rodrigo Quispe ◽  
Laura Mendez-Pino ◽  
Vera Novak ◽  
Magdy Selim ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Acute Stroke ◽  
Continuous Glucose Monitoring ◽  
Poor Prognosis ◽  
Glucose Monitoring ◽  
Mean Amplitude ◽  
P Value ◽  
Stroke Patients ◽  
Glycaemic Variability ◽  
Acute Brain Ischemia

"Hyperglycaemia upon admission is a pathophysiological response to acute brain ischemia that has been independently associated with high mortality rate and poor prognosis. Glycaemic variability (GV) has also shown association with poor clinical outcomes among stroke patients. GV is best assessed by continuous glucose monitoring (CGM), which enables consecutives glucose measurements every 5 minutes. This pilot study aimed: 1) To describe safety, feasibility and tolerability of CGM in the acute stroke setting; and 2) To compare CGM and conventional FS glucose-based monitoring regimen in terms of their relationship with GUA and the accuracy of hypoglycaemic episodes detection. Safety, feasibility and tolerability of CGM was excellent in our cohort of 23 patients with acute stroke (61% ischemic and 39% intracerebral haemorrhage) and there were no adverse events. CGM recorded ten hypoglycaemic episodes that were not detected by conventional FS monitoring. GUA was associated with coefficient of variation (CV) of CGM (p=0.03), CV of FS (p=0.01), standard deviation (SD) of CGM (p-value=0.01) and mean amplitude of glucose excursions (MAGE) (pvalue= 0.001)."

Abstract 82: Differences Between Caucasians and Asians in Intracranial Arterial Stenosis Among TIA and Minor Stroke Patients: Comparisons of Two Contemporary Cohorts

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Xinyi Leng ◽  
Robert Hurford ◽  
Xueyan Feng ◽  
Ka Lung Chan ◽  
Linxin Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ct Angiography ◽  
Interobserver Agreement ◽  
Arterial Stenosis ◽  
Minor Stroke ◽  
Intracranial Arterial Stenosis ◽  
Stroke Patients ◽  
Stroke Registry ◽  
The Difference ◽  
Ischemic Attack

Background: Despite numerous reports indicating ethnic difference in intracranial arterial stenosis (ICAS) between Caucasians and Asians, there has been no direct comparison in disease burden and clinical correlates of ICAS in stroke patients in the two populations with the same criteria to define ICAS. Methods: Acute minor stroke or transient ischemic attack patients who received cerebral MR/CT angiography exam in two cohorts were analyzed: Oxford Vascular Study (OXVASC, 2011-2018) with predominantly Caucasians, and the Chinese University of Hong Kong (CUHK) stroke registry (2011-2015) with predominantly Chinese. ICAS was defined as ≥50% stenosis in any major intracranial artery in MR/CT angiography. Interobserver agreement between 2 investigators for presence of ICAS was assessed in 50 cases with Cohen’s kappa. We compared the burden and risk factors of ICAS in the two cohorts. Results: Overall, 1,287 patients from OXVASC (mean age 69 years) and 640 from the CUHK cohort (mean age 66 years) were analyzed. Interobserver agreement for presence of ICAS was good (kappa=0.82). Prevalence of ICAS was significantly higher in Chinese than in Caucasians: 43.6% in the CUHK cohort versus 20.0% in OXVASC (crude OR 3.10; age-adjusted OR 3.81, 95% CI 3.06-4.75; p<0.001). Mean ages of patients with ICAS in the two cohorts were 75 and 68 years, respectively. The difference between Caucasians and Chinese in ICAS prevalence was smaller in those aged ≥70 years (28.1% versus 51.9%) than those <70 years (9.8% versus 38.0%) (Figure). ICAS shared similar risk factors in the two cohorts, including older age, and history of hypertension and diabetes. Conclusions: Chinese are more susceptible to ICAS, with an earlier onset age than Caucasians, but the ICAS burden in Caucasians was higher than previously estimated, especially in older patients.

scholarly journals FREQUENCY OF FUNCTIONAL DISABILITY AND COGNITIVE IMPAIRMENTS IN SUB-ACUTE STROKE PATIENTS

2021 ◽  
Vol 10 (2) ◽  
pp. 69-74
Author(s):  
Aisha Sarfaraz ◽  
Dr Abdul Azeem ◽  
Mehwish Butt ◽  
Muhammad Umar
Keyword(s):  
Acute Stroke ◽  
Functional Disability ◽  
Cognitive Impairments ◽  
Age Groups ◽  
Female Gender ◽  
Primary Objective ◽  
P Value ◽  
Stroke Patients ◽  
Cross Sectional Survey ◽  
Cross Sectional

BACKGROUND & OBJECTIVE Stroke is a very common neurological condition affects various aspects of health. The primary objective of this study was to find out the frequency of functional disability and cognitive impairments in Sub-acute Stroke patients. MATERIAL AND METHODS A cross-sectional survey was conducted on 112 Sub-acute Stroke patients in Karachi, Pakistan. Using Barthel Index (BI) and Mini-Mental State Examination (MMSE) test was used to find out the frequency of functional disability and cognitive impairments of Sub-acute Stroke patients. RESULTS The correlation of BI scores with MMSE scores for the Male gender was 0.576 whilst the correlation of BI scores with MMSE scores for the Female gender was 0.440. The severity of functional disability concerning age groups assessed P-value was 0.026 using Chi-Square Test. The severity of functional disability (BI severity) concerning gender, P-value was found 0.097 using the same test. CONCLUSION Functional Disability is directly linked with age. However, there was no linkage established between Cognitive Impairment and age as well as gender. On close inspection, there was a trend between Functional disability and gender but not statistically significant.

scholarly journals Admission blood glucose and in-hospital clinical outcome among patients with acute stroke in Inner Mongolia, China

2009 ◽  
Vol 32 (2) ◽  
pp. 151 ◽  
Author(s):  
Ning Wang ◽  
Dawei Qiao ◽  
Weijun Tong ◽  
Fengshan Zhang ◽  
Zhong Ju ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Blood Glucose ◽  
Acute Stroke ◽  
Inner Mongolia ◽  
Odds Ratio ◽  
Logistic Model ◽  
Hemorrhagic Stroke ◽  
Blood Glucose Concentration ◽  
Hospital Death ◽  
Stroke Patients

Purpose: There is still controversy about the association between admission blood glucose concentration and outcome of acute stroke. We studied the association between admission blood glucose and in-hospital death / dependency among acute stroke patients in Inner Mongolia, China. Methods: 2,178 acute ischemic and 1,760 hemorrhagic stroke patients in six hospitals were included in the study. Blood glucose and other study variables were collected within the first 24-hr of hospital admission. Clinical outcomes were evaluated by neurologists during hospitalization. The associations between admission blood glucose and the risk of in-hospital death/dependency were analyzed using a multiple logistic model. Results: There were associations between admission blood glucose and in-hospital death/dependency among patients with acute ischemic or hemorrhagic stroke. Compared with patients with blood glucose < 6.1mmol/L, multivariate-adjusted odds ratio (95% confidence interval) of death/dependency were 0.53 (0.23, 1.27), 2.22 (1.21, 4.11), 1.92 (1.12, 3.33) and 1.91 (1.00, 3.64) for ischemic stroke patients, and 0.93 (0.44, 1.96), 1.42 (0.65, 3.10), 1.98 (1.10, 3.55) and 2.93 (1.40, 6.11) for hemorrhagic stroke patients, with blood glucose 6.1-6.9, 7.0-7.7, 7.8-11.0 and ?11.1mmol/L, respectively. Conclusion: Increased admission blood glucose was associated with death/dependency among patients with acute hemorrhagic and ischemic stroke.

Abstract T P267: Development of an EMS Interfacility Ground Transport Protocol for Patients During/After IV tPA Administration for Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kerrin Connelly ◽  
Rishi Gupta ◽  
Raul Nogueira ◽  
Arthur Yancey ◽  
Alexander Isakov ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Transport Protocol ◽  
Stroke Patients ◽  
Stroke Registry ◽  
The Public ◽  
State Office ◽  
Stroke Center ◽  
Iv Tpa

Purpose: To standardize the care of acute stroke patients who receive IV tPA being transported by ground EMS from a treating hospital to a stroke center. Background: National consensus guidelines exist for the hospital management of patients receiving IV tPA for acute ischemic stroke. Such patients require close monitoring and management to minimize risk of clinical deterioration. Although patients are often emergently transported from local hospitals to a stroke center, there are no treatment specific national guidelines for managing such patients enroute. As a result, there is a need to develop and implement a standardized approach to guide EMS personnel, particularly in states like Georgia where the public health burden of stroke is high. Methods: In 2012, the “Georgia EMS Interfacility Ground Transport Protocol for Patients during/after IV tPA Administration for Acute Ischemic Stroke” was developed in conjunction with the Georgia Coverdell Acute Stroke Registry, the Georgia State Office of EMS, a representative group of Georgia hospitals and EMS providers. Stakeholders were brought together with the goal of creating a unified statewide protocol. The intent was to create a streamlined protocol which could be readily implemented by pre-hospital care providers. Results: Stakeholders discussed challenges and opportunities to change the process of pre-hospital care. Challenges included recognition of the broad diversity of EMS providers representing over 250 agencies in the state. Opportunities included establishing the framework for greater collaboration across organizations and providers. The final protocol was endorsed by both the Georgia Coverdell Acute Stroke Registry and the State Office of EMS, and distributed to all EMS regions in Georgia. EMS agencies are currently implementing the protocol. Conclusion: Engaging a diverse group of statewide stakeholders to develop a new treatment protocol enhances success in implementation and serves to further the public health mission of improving care of acute stroke patients.

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