Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Stroke Vasc Neurol. 2021 Jun;6(2):194-200. doi: 10.1136/svn-2020-000533. Epub 2020 Nov 11.
Administrative data are frequently used in stroke research. Ensuring accurate identification of patients who had an ischaemic stroke, and those receiving thrombolysis and endovascular thrombectomy (EVT) is critical to ensure representativeness and generalisability. We examined differences in patient samples based on mode of identification, and propose a strategy for future patient and procedure identification in large administrative databases.
We used non-public administrative data from the state of California to identify all patients who had an ischaemic stroke discharged from an emergency department (ED) or inpatient hospitalisation from 2010 to 2017 based on International Classification of Disease (ICD-9) (2010-2015), ICD-10 (2015-2017) and Medicare Severity-Diagnosis-related Group (MS-DRG) discharge codes. We identified patients with interhospital transfers, patients receiving thrombolytics and patients treated with EVT based on ICD, Current Procedural Terminology (CPT) and MS-DRG codes. We determined what proportion of these transfers and procedures would have been identified with ICD versus MS-DRG discharge codes.
Of 365 099 ischaemic stroke encounters, most (87.70%) had both a stroke-related ICD-9 or ICD-10 code and stroke-related MS-DRG code; 12.28% had only an ICD-9 or ICD-10 code and 0.02% had only an MS-DRG code. Nearly all transfers (99.99%) were identified using ICD codes. We identified 32 433 thrombolytic-treated patients (8.9% of total) using ICD, CPT and MS-DRG codes; the combination of ICD and CPT codes identified nearly all (98%). We identified 7691 patients treated with EVT (2.1% of total) using ICD and MS-DRG codes; both MS-DRG and ICD-9/ICD-10 codes were necessary because ICD codes alone missed 13.2% of EVTs. CPT codes only pertain to outpatient/ED patients and are not useful for EVT identification.
ICD-9/ICD-10 diagnosis codes capture nearly all ischaemic stroke encounters and transfers, while the combination of ICD-9/ICD-10 and CPT codes are adequate for identifying thrombolytic treatment in administrative datasets. However, MS-DRG codes are necessary in addition to ICD codes for identifying EVT, likely due to favourable reimbursement for EVT-related MS-DRG codes incentivising accurate coding.
行政数据在中风研究中经常被使用。确保准确识别患有缺血性中风的患者以及接受溶栓和血管内血栓切除术（EVT）的患者对于确保代表性和通用性至关重要。我们根据识别方式检查了患者样本之间的差异，并提出了一种在大型行政数据库中识别患者和程序的策略。
我们使用加利福尼亚州的非公开行政数据，根据国际疾病分类（ICD-9）（2010-2015 年）、ICD-10（2015-2017 年）和医疗保险严重程度-诊断相关组（MS-DRG）出院代码，从 2010 年至 2017 年从急诊科（ED）或住院患者中识别出所有患有缺血性中风的患者。我们根据 ICD、当前程序术语（CPT）和 MS-DRG 代码识别出有院内转院、接受溶栓治疗和接受 EVT 治疗的患者。我们确定使用 ICD 与 MS-DRG 出院代码可以识别出多少比例的这些转院和程序。
在 365099 例缺血性中风患者中，大多数（87.70%）既有与中风相关的 ICD-9 或 ICD-10 代码，也有与中风相关的 MS-DRG 代码；12.28%仅有 ICD-9 或 ICD-10 代码，0.02%仅有 MS-DRG 代码。几乎所有的转院（99.99%）都可以通过 ICD 代码识别。我们使用 ICD、CPT 和 MS-DRG 代码识别出 32433 例接受溶栓治疗的患者（占总数的 8.9%）；使用 ICD 和 CPT 代码几乎可以识别出所有患者（98%）。我们使用 ICD 和 MS-DRG 代码识别出 7691 例接受 EVT 治疗的患者（占总数的 2.1%）；仅使用 ICD 和 MS-DRG 代码是必要的，因为 ICD 代码单独漏诊了 13.2%的 EVT。CPT 代码仅适用于门诊/ED 患者，对于 EVT 识别并不有用。
ICD-9/ICD-10 诊断代码几乎可以捕获所有缺血性中风事件和转院，而 ICD-9/ICD-10 和 CPT 代码的组合对于在行政数据集中识别溶栓治疗是足够的。然而，除了 ICD 代码之外，MS-DRG 代码对于识别 EVT 是必要的，这可能是由于与 EVT 相关的 MS-DRG 代码的有利报销激励了准确编码。
