Data quality in the American Heart Association Get With The Guidelines-Stroke (GWTG-Stroke): Results from a National Data Validation Audit

Xian, Ying; Fonarow, Gregg C.; Reeves, Mathew J.; Webb, L.E.; Blevins, Jason R.; Demyanenko, Vladimir S.; Zhao, Xin; Olson, DaiWai M.; Hernandez, Adrian F.; Peterson, Eric D.; Schwamm, Lee H.; Smith, Eric E.

doi:10.1016/j.ahj.2011.12.012

Cited by 146 publications

(155 citation statements)

References 15 publications

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“…18 The validity of data in GWTG-Stroke depends on the accuracy of chart documentation and abstraction; however, a previous central validation audit showed good reliability when data were reabstracted. 19 Finally, because our study was observational, we used regression to control for potential confounders; however, there remains the possibility of residual confounders or unmeasured confounding.…”

Section: Figurementioning

confidence: 99%

Adherence to Third European Cooperative Acute Stroke Study 3- to 4.5-Hour Exclusions and Association With Outcome

Cronin

Sheth

Zhao

et al. 2014

Stroke

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Background and Purpose— The American Heart Association/American Stroke Association guidelines recommend intravenous tissue-type plasminogen activator (tPA) treatment 3 to 4.5 hours from symptom onset according to criteria used in the Third European Cooperative Acute Stroke Study (ECASS III). However, ECASS III excluded certain patient groups in addition to the standard exclusions used for 0 to 3 hours in the United States: age >80 years, history of stroke and diabetes mellitus, oral anticoagulant treatment, and National Institutes of Health Stroke Scale >25. We investigated adherence to these additional exclusion criteria for patients treated 3 to 4.5 hours from onset and their association with outcome. Methods— We analyzed data from Get With The Guidelines-Stroke on 32 019 patients with ischemic stroke from 1464 hospitals who were treated with tPA ≤4.5 hours from onset from January 2009 to January 2012, excluding patients transferred from another hospital. The percent of patients meeting versus not meeting each exclusion criterion were compared between treatment time windows. Results— Overall, 1544 of 4910 (31.5%) patients treated with tPA >3 to 4.5 hours had at least 1 of the additional exclusions, the most common was age >80 years. With the exception of prior stroke and diabetes mellitus, the percent of tPA–treated patients with each exclusion criterion was significantly lower at >3 to 4.5 hours compared with 0 to 3 hours. For each additional exclusion criterion, there was no increased risk of symptomatic intracranial hemorrhage or worse hospital outcome for patients treated >3 to 4.5 hours compared with 0 to 3 hours, after adjusting for baseline differences. Conclusions— Patients with ECASS III–specific exclusion criteria for the >3 to 4.5 hours window are frequently treated with tPA. The presence of the additional exclusion criteria was not associated with worse outcomes in the >3 to 4.5 hours window compared with the 0 to 3 hours window.

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Section: Figurementioning

confidence: 99%

Adherence to Third European Cooperative Acute Stroke Study 3- to 4.5-Hour Exclusions and Association With Outcome

Cronin

Sheth

Zhao

et al. 2014

Stroke

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“…GWTG-S is a hospital-based registry sponsored by the American Heart Association utilized extensively for continuous quality improvement monitoring. 20 Any patient transported by EMS to one of the seven local hospitals with a discharge diagnosis of stroke or TIA was captured in one of the two health care systems' GWTG-S registries. All hospitals within the two health care systems provided registry data to a centralized repository.…”

Section: Data Acquisitionmentioning

confidence: 99%

Assessing the Validity of the Cincinnati Prehospital Stroke Scale and the Medic Prehospital Assessment for Code Stroke in an Urban Emergency Medical Services Agency

Studnek

Asimos

Dodds

et al. 2013

Prehospital Emergency Care

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Objectives. The primary objective of this study was to assess the effectiveness of two prehospital stroke screens in correctly classifying patients suspected of having a stroke. Secondarily, differences in the sensitivity and specificity of the two screening tools were assessed. Methods. We performed a retrospective assessment of the Cincinnati Prehospital Stroke Scale (CPSS) and the Medic Prehospital Assessment for Code Stroke (Med PACS) between March 1, 2011, and September 30, 2011, in a single emergency medical services (EMS) agency with seven local hospitals all classified as stroke-capable. We obtained data for this analysis from the EMS electronic patient care reports (ePCRs) and the Get With The Guidelines − Stroke (GWTG-S) registries maintained by the two local health care systems by matching on patient identifiers. The Med PACS was developed specifically for the EMS agency under study by a local team of neurologists, emergency physicians, and paramedics. All of the physical assessment elements of the CPSS were included within the Med PACS. Two additional physical assessment items, gaze and leg motor function, were included in the Med PACS. We classified patients as CPSS-positive or -negative and Med PACS-positive or -negative if any one of the physical assessment findings was present. We determined the presence of a hospital discharge diagnosis of stroke from GWTG-S. We calculated sensitivity and specificity with resultant 95% confidence intervals. Results. We enrolled 416 patients in this study, of whom 186 (44.7%) were diagnosed with a stroke and the specificity of the Med PACS was significantly higher compared with the CPSS, with a difference in specificity of 0.086 (95% CI 0.042-0.131), p < 0.001. Conclusion. The two stroke scales under study demonstrated low sensitivity and specificity, with each scale performing marginally better in one of the two metrics assessed.

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“…The eligibility of each acute stroke is confirmed at chart review before abstraction, and the specificity of included patients and data accuracy have been demonstrated to be high. 14 After abstraction by trained personnel at each hospital, deidentified patient data are entered into the GWTG-Stroke database with the use of a web-based patient management tool (Outcome, A Quintiles Company, Cambridge, MA). Data elements abstracted include patient demographics, medical history and comorbidities, initial brain imaging findings, in-hospital treatment and events, discharge disposition, ambulatory status, and mortality.…”

mentioning

confidence: 99%

Why are acute ischemic stroke patients not receiving IV tPA?

et al. 2016

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Objective: To determine patient and hospital characteristics associated with not providing IV tissue plasminogen activator (tPA) to eligible patients with acute ischemic stroke (AIS) in clinical practice.Methods: We performed a retrospective cohort study of patients with AIS arriving within 2 hours of onset to hospitals participating in Get With The Guidelines-Stroke without documented contraindications to IV tPA from April 2003 through December 2011, comparing those who received tPA to those who did not. Multivariable generalized estimating equation logistic regression modeling identified factors associated with not receiving tPA.Results: Of 61,698 eligible patients with AIS presenting within 2 hours of onset (median age 73 years, 51% female, 74% non-Hispanic white, median NIH Stroke Scale score 11, interquartile range 6-18), 15,282 (25%) were not treated with tPA within 3 hours. Failure to give tPA decreased over time from 55% in 2003 to 2005 to 18% in 2010 to 2011 (p , 0.0001). After adjustment for all covariates, including stroke severity, factors associated with failure to treat included older age, female sex, nonwhite race, diabetes mellitus, prior stroke, atrial fibrillation, prosthetic heart valve, NIH Stroke Scale score ,5, arrival off-hours and not via emergency medical services, longer onset-to-arrival and door-to-CT times, earlier calendar year, and arrival at rural, nonteaching, non-stroke center hospitals located in the South or Midwest.Conclusions: Overall, about one-quarter of eligible patients with AIS presenting within 2 hours of stroke onset failed to receive tPA treatment. Thrombolysis has improved dramatically over time and is strongly associated with stroke center certification. Additionally, some groups, including older patients, milder strokes, women, and minorities, may be undertreated.

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Data quality in the American Heart Association Get With The Guidelines-Stroke (GWTG-Stroke): Results from a National Data Validation Audit

Cited by 146 publications

References 15 publications

Adherence to Third European Cooperative Acute Stroke Study 3- to 4.5-Hour Exclusions and Association With Outcome

Adherence to Third European Cooperative Acute Stroke Study 3- to 4.5-Hour Exclusions and Association With Outcome

Assessing the Validity of the Cincinnati Prehospital Stroke Scale and the Medic Prehospital Assessment for Code Stroke in an Urban Emergency Medical Services Agency

Why are acute ischemic stroke patients not receiving IV tPA?

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