Kleindorfer Dawn, Lindsell Christopher J, Brass Lawrence, Koroshetz Walter, Broderick Joseph P
University of Cincinnati College of Medicine, Department of Neurology, 231 Albert Sabin Way ML 0525, Cincinnati, Ohio 45267-0525, USA.
Stroke. 2008 Mar;39(3):924-8. doi: 10.1161/STROKEAHA.107.490375. Epub 2008 Jan 31.
Current US estimates of recombinant tissue plasminogen activator (rt-PA) use have been based either on extrapolation of regional studies or on administrative database estimates, both of which may have inherent biases. We sought to compare the utilization of rt-PA in acute ischemic stroke in the MEDPAR database to another national hospital database with drug utilization information.
Cases were defined as DRG 14,15, and 524 and ICD-9 code 99.1, which indicates cerebral thrombolysis, for fiscal year 2001 to 2004. Additionally, the Premier database was queried for rt-PA utilization documented in pharmacy records in those patients admitted for stroke. Change over time and difference between databases were tested using Poisson regression.
When comparing databases, rt-PA use, as identified by ICD-9 code 99.1, was only documented in 0.95% of stroke cases in 2004 in MEDPAR, and 1.2% in the Premier database, which slightly increased by 0.04% to 0.09% over time. Analysis of pharmacy billing records increased the estimate to 1.82%. Exclusion of cases younger than 65 years excluded 43% of cases treated with rt-PA. In 2004, 12.7% of cases receiving thrombolytic had either a TIA or a hemorrhagic stroke ICD-9 code.
We estimate the rate of rt-PA use in the United States to be 1.8% to 2.1% of ischemic stroke patients. The rate of thrombolytic use for ischemic stroke was slightly increasing between 2001 and 2004 at a rate of 0.04% to 0.09% per year. A significant proportion of patients treated with rt-PA are likely miscoded as either TIA or hemorrhagic stroke. We conservatively estimate that 10,800 to 12,600 patients received rt-PA in 2004.
目前美国对重组组织型纤溶酶原激活剂（rt-PA）使用情况的估计，要么基于区域研究的推断，要么基于行政数据库估计，而这两种方法都可能存在固有偏差。我们试图将MEDPAR数据库中急性缺血性卒中患者rt-PA的使用情况与另一个包含药物使用信息的全国性医院数据库进行比较。
病例定义为2001财年至2004财年的诊断相关分组（DRG）14、15和524以及国际疾病分类第九版（ICD-9）编码99.1，该编码表示脑溶栓治疗。此外，还查询了Premier数据库中因卒中入院患者药房记录中记录的rt-PA使用情况。使用泊松回归检验随时间的变化以及数据库之间的差异。
比较数据库时，2004年在MEDPAR中，通过ICD-9编码99.1确定的rt-PA使用情况仅在0.95%的卒中病例中有记录，在Premier数据库中为1.2%，随时间略有增加，从0.04%增至0.09%。对药房计费记录的分析将估计值提高到了1.82%。排除65岁以下病例后，排除了43%接受rt-PA治疗的病例。2004年，接受溶栓治疗的病例中有12.7%的ICD-9编码为短暂性脑缺血发作（TIA）或出血性卒中。
我们估计美国rt-PA的使用率为缺血性卒中患者的1.8%至2.1%。2001年至2004年期间，缺血性卒中的溶栓使用率以每年0.04%至0.09%的速度略有上升。很大一部分接受rt-PA治疗的患者可能被错误编码为TIA或出血性卒中。我们保守估计2004年有10,800至12,600名患者接受了rt-PA治疗。
