Validation of Emergency and Final Diagnosis Coding in Transient Ischemic Attack: South Western Sydney Transient Ischemic Attack Study

Ghia, Darshan; Thomas, Peter; Cordato, Dennis; Worthington, John; Cappelen‐Smith, Cecilia; Griffith, Neil; Hanna, Ibrahim; Hodgkinson, S.; McDougall, Alan; Beran, Roy G.

doi:10.1159/000310338

Cited by 29 publications

(34 citation statements)

References 27 publications

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“…[23][24][25] In our study, the discharge diagnosis of TIA agreed with the diagnosis after being seen in the neurovascular clinic in 86.4% of patients. Including or excluding these patients did not change our results.…”

Section: Discussionsupporting

confidence: 73%

Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic

Hosier

Phillips

Doucette

et al. 2016

CJEM

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Objectives: 1) To evaluate whether transient ischemic attack (TIA) management in emergency departments (EDs) of the Nova Scotia Capital District Health Authority followed Canadian Best Practice Recommendations, and 2) to assess the impact of being followed up in a dedicated outpatient neurovascular clinic. Methods: Retrospective chart review of all patients discharged from EDs in our district from January 1, 2011 to December 31, 2012 with a diagnosis of TIA. Cox proportional hazards models, Kaplan-Meier survival curve, and propensity matched analyses were used to evaluate 90-day mortality and readmission. Results: Of the 686 patients seen in the ED for TIA, 88.3% received computed tomography (CT) scanning, 86.3% received an electrocardiogram (ECG), 35% received vascular imaging within 24 hours of triage, 36% were seen in a neurovascular clinic, and 4.2% experienced stroke, myocardial infarction, or vascular death within 90 days. Rates of antithrombotic use were increased in patients seen in a neurovascular clinic compared to those who were not (94% v. 86.3%, p < 0.0001). After adjustment for age, sex, vascular disease risk factors, and stroke symptoms, the risk of readmission for stroke, myocardial infarction, or vascular death was lower for those seen in a neurovascular clinic compared to those who were not (adjusted hazard ratio 0.28; 95% confidence interval 0.08-0.99, p = 0.048). Conclusion: The majority of patients in our study were treated with antithrombotic agents in the ED and investigated with CT and ECG within 24 hours; however, vascular imaging and neurovascular clinic follow-up were underutilized. For those with neurovascular clinic follow-up, there was an association with reduced risk of subsequent stroke, myocardial infarction, or vascular death. RÉSUMÉObjectifs: L'étude visait, d'une part, à examiner si la prise en charge des accidents ischémiques transitoires (AIT) au service des urgences de la région sanitaire Nova Scotia Capital District Health Authority respectait les recommandations canadiennes en matière de pratiques exemplaires, et, d'autre part, à évaluer l'incidence du suivi dans un service de consultations externes, spécialisé en maladies neurovasculaires. Méthode: Les auteurs ont procédé à un examen rétrospectif des dossiers de tous les patients chez qui avait été posé un diagnostic d'AIT et qui avaient reçu leur congé du SU, dans la région mentionnée, et ce, du 1 er janvier 2011 au 31 décembre 2012. La mortalité et le taux de réadmission au bout de 90 jours ont été calculés à l'aide de modèles de risques proportionnels de Cox, de la méthode d'estimation de Kaplan-Meyer et d'analyses appariées de propension. Résultats: Sur 686 patients examinés au SU pour un AIT, 88,3% ont été soumis à une tomodensitométrie (TDM); 86,3%, à un ECG; 35%, à un examen par imagerie vasculaire dans les 24 heures suivant le triage et 36% ont été vus dans un service de consultations spécialisé en maladies neurovasculaires; 4,2% ont subi un accident vasculaire cérébral (AVC) ou un infarctus du myocarde (...

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Section: Discussionsupporting

confidence: 73%

Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic

Hosier

Phillips

Doucette

et al. 2016

CJEM

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“…18 A small proportion of patients with TIA mimics are coded as TIA. 19 The DRG system has been used in previous studies pertaining to costs and length of stay of stroke patients. 20 We think that using a combination of DRG and ICD-9-CM codes would result in higher accuracy for TIA patient identification.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Length of Hospitalization in Patients Admitted With Transient Ischemic Attack in United States

Qureshi

Adil

Zacharatos

et al. 2013

Stroke

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Background and Purpose-Approximately 70% of all patients presenting with transient ischemic attack are admitted to the hospital in United States. The duration and cost of hospitalization and associated factors are poorly understood. This article seeks to identify the proportion and determinants of prolonged hospitalization and to determine the impact on hospital charges using nationally representative data. Methods-We determined the national estimates of length of stay, mortality, and charges incurred in patients admitted with transient ischemic attack (diagnosis-related code 524 or 069) using Nationwide Inpatient Sample data from 2002 to 2010. Nationwide Inpatient Sample is the largest all-payer inpatient care database in the United States and contains data from ≈1000 hospitals, which is a 20% stratified sample of US community hospitals. All the variables pertaining to hospitalization were compared in 3 groups on the basis of length of hospital stay (≤1, 2-6, and ≥7 days). Results-A total of 949 558 patients were admitted with the diagnosis of transient ischemic attack during the study period.The length of hospitalization was ≤1, 2 to 6, and ≥7 days in 232 732 (24.4%), 662 909 (70%), and 53 917 (5.6%) patients, respectively. The mean hospitalization charges were $10 876, $17 187, and $38 200 for patients hospitalized for ≤1, 2 to 6, and ≥7 days, respectively. The use of thrombolytics (0.03%, 0.09%, and 0.1%; P<0.0001) for ischemic stroke was very low among the 3 strata defined by length of hospitalization. In the multivariate analysis, the following factors were associated with length of hospitalization of ≥2 days: age >65 years (odds ratio [OR], 1.5), women (OR, 1.2), admission to teaching hospitals (OR, 1

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“…We present data on TIA admissions to all hospitals within the state of New South Wales (NSW), Received August 15, 2011; accepted September 9, 2011 We identified and excluded potential mimic disorders based on an Australian validation study of TIA hospital coding, which identified recognized diagnoses mistaken for TIA at presentation, including stroke, epilepsy and convulsions, migraine, traumatic brain injury, primary and secondary cerebral malignancies, syncope and collapse, toxic-metabolic disturbances, neurodegenerative conditions, and sepsis, including central nervous system infections. 21 We expected approximately 12% of identified patients with TIA to be misclassified cases. 21 Patients with a prior hospitalization for stroke were not excluded.…”

mentioning

confidence: 98%

“…21 We expected approximately 12% of identified patients with TIA to be misclassified cases. 21 Patients with a prior hospitalization for stroke were not excluded.Data linkage was performed centrally by a government and university-sponsored organization carrying out deidentified data linkage of routinely collected administrative data. 20…”

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confidence: 98%

“…Assessing misclassification is difficult but we have deliberately studied patients with a hospital TIA diagnosis, and these diagnoses have been previously validated and found to be highly accurate. 21 Relative to the general population, females were found to have a significantly lower risk of excess death than males. A recent US study of patients with TIA Ͼ65 years, also using hospitalization data, reported that women were significantly less likely than men to die in the year after a TIA.…”

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confidence: 99%

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Relative Survival After Transient Ischaemic Attack

Gattellari

Goumas

Biost

et al. 2012

Stroke

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Background and Purpose-There is a lack of modern-day data quantifying the effect of transient ischemic attack (TIA) on survival, and recent data do not take into account expected survival. Methods-Data for 22 157 adults hospitalized with a TIA from July 1, 2000, to June 30, 2007, in New South Wales, Australia, were linked with registered deaths to June 30, 2009. We estimated survival relative to the age-and sex-matched general population up to 9-years after hospitalization for TIA comparing relative risk of excess death between selected subgroups. Results-At 1 year, 91.5% of hospitalized patients with TIA survived compared with 95.0% expected survival in the general population. After 5 years, observed survival was 13.2% lower than expected in relative terms. By 9 years, observed survival was 20% lower than expected. Females had higher relative survival than males (relative risk, 0.79; 95% CI, 0.69 -0.90; PϽ0.001). Increasing age was associated with an increasing risk of excess death compared with the age-matched population. Prior hospitalization for stroke (relative risk, 2.63; 95% CI, 1.98 -3.49) but not TIA (relative risk, 1.42; 95% CI, 0.86 -2.35) significantly increased the risk of excess death. Of all risk factors assessed, congestive heart failure, atrial fibrillation, and prior hospitalization for stroke most strongly impacted survival. Conclusions-This study is the first to quantify the long-term effect of hospitalized TIA on relative survival according to age, sex, and medical history. TIA reduces survival by 4% in the first year and by 20% within 9 years. TIA has a minimal effect on mortality in patients Ͻ50 years but heralds significant reduction in life expectancy in those Ͼ65 years. Key Words: follow-up Ⅲ relative survival Ⅲ transient ischaemic attack T ransient ischemic attack (TIA) is a recognized predictor of early stroke risk and its stroke outcomes have attracted intense interest. Early stroke rates vary 1,2 and recent studies report low early stroke risk with modern urgent TIA care. [3][4][5][6] In contrast to the emphasis on early stroke risk, detailed analyses of survival after TIA, and how survival varies by age, sex, and medical history have rarely been reported. Multicenter or population-based reports suggest that between 5% and 8% of patients will die within 6 months of their TIA, 7,8 and others report 5% to 15% dying by 1 year. 3,9 -11 However, the significance of these findings is uncertain. Given the advanced age at which TIA commonly occurs, it is unclear whether the observed mortality exceeds otherwise expected mortality.Calculating relative survival accounts for the "background risk" of death and identifies the excess risk of mortality above and beyond that expected from the age-and sex-matched general population. Previous population-based or multicenter studies reporting relative survival are only of historic interest with cohorts recruited from 1950 to 1988. 11-16 These studies are small-scale in terms of geographical scope and sample size (79 -330 participants), further lim...

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Validation of Emergency and Final Diagnosis Coding in Transient Ischemic Attack: South Western Sydney Transient Ischemic Attack Study

Cited by 29 publications

References 27 publications

Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic

Transient ischemic attack: management in the emergency department and impact of an outpatient neurovascular clinic

Factors Associated With Length of Hospitalization in Patients Admitted With Transient Ischemic Attack in United States

Relative Survival After Transient Ischaemic Attack

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