Developing a stroke severity index based on administrative data was feasible using data mining techniques

Sung, Sheng Feng; Hsieh, Cheng Yang; Yang, Yea Huei Kao; Lin, Huey Juan; Chen, Chih‐Hung; Chen, Yu Wei; Hu, Yu

doi:10.1016/j.jclinepi.2015.01.009

Cited by 121 publications

(112 citation statements)

References 36 publications

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“…[31][32][33][34][35] It can also be used to predict acute vessel occlusion, even though accuracy is relatively low. 36 We did not find any correlation between serum cystatin C levels and NIHSS scores.…”

Section: Table 3 Distribution Of Serum Vascular Risk Factors and Nihsmentioning

confidence: 99%

Association between serum cystatin C levels and the severity or potential risk factors of acute ischemic stroke

Huang

Ding

et al. 2016

Neurological Research

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Section: Table 3 Distribution Of Serum Vascular Risk Factors and Nihsmentioning

confidence: 99%

Association between serum cystatin C levels and the severity or potential risk factors of acute ischemic stroke

Huang

Ding

et al. 2016

Neurological Research

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“…[16,17] To overcome this inherent shortcoming, we have developed a 7-item claims-based stroke severity index (SSI), which correlates well with initial stroke severity as assessed by using the NIHSS. [18] This novel index has been satisfactorily applied to estimate stroke severity in patients hospitalized for ischemic stroke in our other claims-based study. [19] …”

Section: Introductionmentioning

confidence: 99%

“Weekend effect” on stroke mortality revisited

et al. 2016

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Previous studies have yielded inconsistent results on whether weekend admission is associated with increased mortality after stroke, partly because of differences in case mix. Claims-based studies generally lack sufficient information on disease severity and, thus, suffer from inadequate case-mix adjustment. In this study, we examined the effect of weekend admission on 30-day mortality in patients with ischemic stroke by using a claims-based stroke severity index.This was an observational study using a representative sample of the National Health Insurance claims data linked to the National Death Registry. We identified patients hospitalized for ischemic stroke, and examined the effect of weekend admission on 30-day mortality with vs without adjustment for stroke severity by using multilevel logistic regression analysis adjusting for patient-, physician-, and hospital-related factors. We analyzed 46,007 ischemic stroke admissions, in which weekend admissions accounted for 23.0%. Patients admitted on weekends had significantly higher 30-day mortality (4.9% vs 4.0%, P < 0.001) and stroke severity index (7.8 vs 7.4, P < 0.001) than those admitted on weekdays. In multivariate analysis without adjustment for stroke severity, weekend admission was associated with increased 30-day mortality (odds ratio (OR), 1.20; 95% confidence interval [CI], 1.08–1.34). This association became null after adjustment for stroke severity (OR, 1.07; 95% CI, 0.95–1.20).The “weekend effect” on stroke mortality might be attributed to higher stroke severity in weekend patients. While claims data are useful for examining stroke outcomes, adequate adjustment for stroke severity is warranted.

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“…Nevertheless, the claims-based SSI calculated as a representative of neurological deficit matched well between two cohorts after tallying their propensity scores. A previous study on outcomes research using administrative data indicated that the SSI is a potential proxy indicator for ischaemic stroke severity 41. There is a significant correlation between the SSI and clinical stroke severity, scored in accordance to the National Institutes of Health Stroke Scale, and also there is significant association between SSI and the modified Rankin Scale, which is used for follow-up evaluations 61.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study on outcomes research using administrative data indicated that the SSI is a potential proxy indicator for ischaemic stroke severity. 41 There is a significant correlation between the SSI and clinical stroke severity, scored in accordance to the National Institutes of Health Stroke Scale, and also there is significant association between SSI and the modified Rankin Scale, which is used for follow-up evaluations. 61 Therefore, differences in stroke severity between the thiazide and non-thiazide cohorts were diminished after adequate matching.…”

Section: Discussionmentioning

confidence: 99%

“…The SSI score was also calculated to predict the severity of the neurological deficit. The claims-based SSI developed by Sung et al 41 is highly correlated with the National Institutes of Health Stroke Scale. The baseline comorbidities and use of medications which were considered as possible potential confounders (listed in table 1) were selected according to previous studies 42–48.…”

Section: Methodsmentioning

confidence: 99%

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Thiazide diuretics and the risk of hip fracture after stroke: a population-based propensity-matched cohort study using Taiwan’s National Health Insurance Research Database

et al. 2017

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ObjectivesThis study aimed to investigate the association between thiazide use and the risk of hip fracture after stroke.SettingA population-based, propensity-matched cohort study was conducted on the basis of Taiwan’s National Health Insurance Research Database.ParticipantsPatients with newly diagnosed ischaemic stroke between 2000 and 2011 were included. After propensity score matching, 7470 patients were included, of whom 3735 received thiazides and 3735 did not.Outcome measuresHRs for developing hip fractures within 2 years after stroke were calculated using Cox proportional hazards regression model with adjustments for sociodemographic and coexisting medical conditions.ResultsOverall, patients using thiazides after stroke had a lower risk of hip fracture than those not using thiazides (8.5 vs 13.9 per 1000 person-years, adjusted HR=0.64, 95% CI 0.46 to 0.89, p=0.007). Further sensitivity analysis based on the duration of thiazide use revealed that the risk of hip fracture tended to decrease as the duration of exposure of thiazides increased. However, the effect was significant only in patients with long-term use of thiazides (using thiazides for >365 days within 2 years after stroke), with a 59% reduction in the risk of hip fracture when compared with patients not using thiazide (adjusted HR=0.41, 95% CI 0.22 to 0.79, p=0.008).ConclusionsThe long-term use of thiazides is associated with a decreased risk of hip fracture after stroke.

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Developing a stroke severity index based on administrative data was feasible using data mining techniques

Cited by 121 publications

References 36 publications

Association between serum cystatin C levels and the severity or potential risk factors of acute ischemic stroke

Association between serum cystatin C levels and the severity or potential risk factors of acute ischemic stroke

“Weekend effect” on stroke mortality revisited

Thiazide diuretics and the risk of hip fracture after stroke: a population-based propensity-matched cohort study using Taiwan’s National Health Insurance Research Database

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