Recent trends in the treatment of spontaneous intracerebral hemorrhage: analysis of a nationwide inpatient database

Andaluz, Norberto; Zuccarello, Mario

doi:10.3171/2008.5.17559

Cited by 74 publications

(50 citation statements)

References 41 publications

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“…1,3,11,21 The main disadvantages of such analyses are the lack of postdischarge follow-up and the lack of inpatient outcome metrics more detailed than discharge status. Coding accuracy also may be a limitation.…”

Section: Discussionmentioning

confidence: 99%

Health care burden of cervical spine fractures in the United States: analysis of a nationwide database over a 10-year period

Baaj

Uribe

Nichols

et al. 2010

SPI

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Object The objective of this work was to search a national health care database of patients diagnosed with cervical spine fractures in the US to analyze discharge, demographic, and hospital charge trends over a 10-year period. Methods Clinical data were derived from the Nationwide Inpatient Sample (NIS) for the years 1997 through 2006. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the US. Patients with cervical spine fractures with and without spinal cord injury (SCI) were identified using the appropriate ICD-9-CM codes. The volume of discharges, length of stay (LOS), hospital charges, total national charges, discharge pattern, age, and sex were analyzed. National estimates were calculated using the HCUPnet tool. Results Approximately 200,000 hospitalizations were identified. In the non-SCI group, there was a 74% increase in hospitalizations and charges between 1997 and 2006, but LOS changed minimally. There was no appreciable change in the rate of in-hospital mortality (< 3%), but discharges home with home health care and to skilled rehabilitation or nursing facilities increased slightly. In the SCI group, hospitalizations and charges increased by 29 and 38%, respectively. There were no significant changes in LOS or discharge status in this group. Spinal cord injury was associated with increases in LOS, charges, and adverse outcomes compared with fractures without SCI. Total national charges associated with both groups combined exceeded $1.3 billion US in 2006. Conclusions During the studied period, increases in hospitalizations and charges were observed in both the SCI and non-SCI groups. The percentage increase was higher in the non-SCI group. Although SCI was associated with higher adverse outcomes, there were no significant improvements in immediate discharge status in either group during the 10 years analyzed.

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Section: Discussionmentioning

confidence: 99%

Health care burden of cervical spine fractures in the United States: analysis of a nationwide database over a 10-year period

Baaj

Uribe

Nichols

et al. 2010

SPI

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“…Our results were similar whether adjusting for demographics alone or demographics plus stroke severity and comorbid illness. Other studies reporting trends in ICH case fatality have had mixed results, with most showing generally stable case fatality 3,14,17,19,24 and others showing a modest decrease. [25][26][27] Some of the studies that did show a decrease examined in-hospital death based on administrative datasets with more than 100,000 ICH cases and therefore had greater power to detect small differences.…”

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confidence: 97%

Intracerebral hemorrhage mortality is not changing despite declining incidence

Zahuranec¹,

Lisabeth²,

Sánchez³

et al. 2014

Neurology

149

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Objective: To determine trends in incidence and mortality of intracerebral hemorrhage (ICH) in a rigorous population-based study. Methods:We identified all cases of spontaneous ICH in a South Texas community from 2000 to 2010 using rigorous case ascertainment methods within the Brain Attack Surveillance in Corpus Christi Project. Yearly population counts were determined from the US Census, and deaths were determined from state and national databases. Age-, sex-, and ethnicity-adjusted incidence was estimated for each year with Poisson regression, and a linear trend over time was investigated. Trends in 30-day case fatality and long-term mortality (censored at 3 years) were estimated with log-binomial or Cox proportional hazards models adjusted for demographics, stroke severity, and comorbid disease.Results: A total of 734 cases of ICH were included. The age-, sex-, and ethnicity-adjusted ICH annual incidence rate was 5.21 per 10,000 (95% confidence interval [CI] 4.36, 6.24) in 2000 and 4.30 per 10,000 (95% CI 3.21, 5.76) in 2010. The estimated 10-year change in demographic-adjusted ICH annual incidence rate was 231% (95% CI 247%, 211%). Yearly demographic-adjusted 30-day case fatality ranged from 28.3% (95% CI 19.9%, 40.3%) in 2006 to 46.5% (95% CI 35.5, 60.8) in 2008. There was no change in ICH case fatality or long-term mortality over time.Conclusions: ICH incidence decreased over the past decade, but case fatality and long-term mortality were unchanged. This suggests that primary prevention efforts may be improving over time, but more work is needed to improve ICH treatment and reduce the risk of death. Intracerebral hemorrhage (ICH) accounts for about 10% of all strokes but a disproportionate amount of stroke mortality.1 Incidence of ischemic stroke is declining, 2 and due to shared risk factors, ICH incidence may be expected to be declining as well. Limited data exist on recent trends in ICH burden. Trends in ICH incidence and case fatality were the subject of a 2010 systematic review, 3 though most of the included 36 studies were from before 2000, and few were specifically designed to investigate time trends. An understanding of time trends in the epidemiology of ICH incidence, case fatality, and long-term mortality is necessary to gauge the effectiveness of stroke prevention and treatment efforts.Due to improved control of risk factors such as hypertension over the past decade, 4 there is a need for more recent data on trends in ICH. The objective of this analysis was to investigate trends in ICH incidence, 30-day case fatality, and long-term mortality from 2000 to 2010 within the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project.

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“…This issue has been raised before. 1,3,10 When it comes to unique procedures, such as implantation of a VNS device, the coding is probably more accurate and consistent. Another limitation is that the data originate from a selected number of US hospitals, which may introduce bias in patient selection.…”

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confidence: 99%

The health care burden of patients with epilepsy in the United States: an analysis of a nationwide database over 15 years

Vivas¹,

Baaj²,

Benbadis

et al. 2012

FOC

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Object The aim of this study was to analyze the national health care burden of patients diagnosed with epilepsy in the US and to analyze any changes in the length of stay, mean charges, in-hospital deaths (mortality), and disposition at discharge. Methods A retrospective review of the Nationwide Inpatient Sample (NIS) database for epilepsy admissions was completed for the years from 1993 to 2008. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the US. Patients with epilepsy were identified using ICD-9 codes beginning with 345.XX. Approximately 1.1 million hospital admissions were identified over a span of 15 years. Results Over this 15-year period (between 1993 and 2008), the average hospital charge per admission for patients with epilepsy has increased significantly (p < 0.001) from $10,050 to $23,909, an increase of 137.9%. This is in spite of a 33% decrease in average length of stay from 5.9 days to 3.9 days. There has been a decrease in the percentage of in-hospital deaths by 57.9% and an increase in discharge to outside medical institutions. Conclusions The total national charges associated with epilepsy in 2008 were in excess of $2.7 billion (US dollars, normalized). During the studied period, the cost per day for patients rose from $1703.39 to $6130.51. In spite of this drastic increase in health care cost to the patient, medical and surgical treatment for epilepsy has not changed significantly, and epilepsy remains a major source of morbidity.

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Recent trends in the treatment of spontaneous intracerebral hemorrhage: analysis of a nationwide inpatient database

Cited by 74 publications

References 41 publications

Health care burden of cervical spine fractures in the United States: analysis of a nationwide database over a 10-year period

Health care burden of cervical spine fractures in the United States: analysis of a nationwide database over a 10-year period

Intracerebral hemorrhage mortality is not changing despite declining incidence

The health care burden of patients with epilepsy in the United States: an analysis of a nationwide database over 15 years

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