Creation and Validation of a Stroke Scale to Increase Utility of National Inpatient Sample Administrative Data for Clinical Stroke Research

The National Inpatient Sample (NIS) has led to several breakthroughs via large sample size. However, utility of NIS is limited by the lack of admission NIHSS and 90-day modified Rankin score (mRS). This study creates estimates for stroke severity at admission and 90-day mRS using NIS data for acute...

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Veröffentlicht in:Journal of stroke and cerebrovascular diseases 2021-04, Vol.30 (4), p.105658-105658, Article 105658
Hauptverfasser: Patel, Pious D., Salwi, Sanjana, Liles, Campbell, Mistry, Akshitkumar M., Mistry, Eva A., Fusco, Matthew R., Chitale, Rohan V., Shannon, Chevis N.
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container_end_page 105658
container_issue 4
container_start_page 105658
container_title Journal of stroke and cerebrovascular diseases
container_volume 30
creator Patel, Pious D.
Salwi, Sanjana
Liles, Campbell
Mistry, Akshitkumar M.
Mistry, Eva A.
Fusco, Matthew R.
Chitale, Rohan V.
Shannon, Chevis N.
description The National Inpatient Sample (NIS) has led to several breakthroughs via large sample size. However, utility of NIS is limited by the lack of admission NIHSS and 90-day modified Rankin score (mRS). This study creates estimates for stroke severity at admission and 90-day mRS using NIS data for acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT). Three patient cohorts undergoing MT for AIS were utilized: Cohort 1 (N = 3729) and Cohort 3 (N = 1642) were derived from NIS data. Cohort 2 (N=293) was derived from a prospectively-maintained clinical registry. Using Cohort 1, Administrative Stroke Outcome Variable (ASOV) was created using disposition and mortality. Factors reflective of stroke severity were entered into a stepwise logistic regression predicting poor ASOV. Odds ratios were used to create the Administrative Data Stroke Scale (ADSS). Performances of ADSS and ASOV were tested using Cohort 2 and compared with admission NIHSS and 90-day mRS, respectively. ADSS performance was compared with All Patient Refined-Diagnosis Related Group (APR-DRG) severity score using Cohort 3. Agreement of ASOV with 90-day mRS > 2 was fair (κ = 0.473). Agreement with 90-day mRS > 3 was substantial (κ = 0.687). ADSS significantly correlated (p  15. ADSS performed comparably (AUC = 0.749) to admission NIHSS (AUC = 0.697) in predicting 90-day mRS > 2 and mRS > 3 (AUC = 0.767, 0.685, respectively). ADSS outperformed APR-DRG severity score in predicting poor ASOV (AUC = 0.698, 0.682, respectively). We developed and validated measures of stroke severity at admission (ADSS) and outcome (ASOV, estimate for 90-day mRS > 3) to increase utility of NIS data in stroke research.
doi_str_mv 10.1016/j.jstrokecerebrovasdis.2021.105658
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However, utility of NIS is limited by the lack of admission NIHSS and 90-day modified Rankin score (mRS). This study creates estimates for stroke severity at admission and 90-day mRS using NIS data for acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT). Three patient cohorts undergoing MT for AIS were utilized: Cohort 1 (N = 3729) and Cohort 3 (N = 1642) were derived from NIS data. Cohort 2 (N=293) was derived from a prospectively-maintained clinical registry. Using Cohort 1, Administrative Stroke Outcome Variable (ASOV) was created using disposition and mortality. Factors reflective of stroke severity were entered into a stepwise logistic regression predicting poor ASOV. Odds ratios were used to create the Administrative Data Stroke Scale (ADSS). Performances of ADSS and ASOV were tested using Cohort 2 and compared with admission NIHSS and 90-day mRS, respectively. ADSS performance was compared with All Patient Refined-Diagnosis Related Group (APR-DRG) severity score using Cohort 3. Agreement of ASOV with 90-day mRS &gt; 2 was fair (κ = 0.473). Agreement with 90-day mRS &gt; 3 was substantial (κ = 0.687). ADSS significantly correlated (p &lt; 0.001) with clinically-significant admission NIHSS &gt; 15. ADSS performed comparably (AUC = 0.749) to admission NIHSS (AUC = 0.697) in predicting 90-day mRS &gt; 2 and mRS &gt; 3 (AUC = 0.767, 0.685, respectively). ADSS outperformed APR-DRG severity score in predicting poor ASOV (AUC = 0.698, 0.682, respectively). 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ADSS performance was compared with All Patient Refined-Diagnosis Related Group (APR-DRG) severity score using Cohort 3. Agreement of ASOV with 90-day mRS &gt; 2 was fair (κ = 0.473). Agreement with 90-day mRS &gt; 3 was substantial (κ = 0.687). ADSS significantly correlated (p &lt; 0.001) with clinically-significant admission NIHSS &gt; 15. ADSS performed comparably (AUC = 0.749) to admission NIHSS (AUC = 0.697) in predicting 90-day mRS &gt; 2 and mRS &gt; 3 (AUC = 0.767, 0.685, respectively). ADSS outperformed APR-DRG severity score in predicting poor ASOV (AUC = 0.698, 0.682, respectively). 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subjects Administrative Claims, Healthcare
Administrative Database
Aged
Databases, Factual
Disability Evaluation
Female
Humans
Inpatients
Ischemic Stroke - diagnosis
Ischemic Stroke - drug therapy
Ischemic Stroke - epidemiology
Male
Mechanical Thrombectomy
Middle Aged
modified Rankin Scale
National Inpatient Sample
NIH Stroke Scale
Patient Admission
Predictive Value of Tests
Registries
Reproducibility of Results
Severity of Illness Index
Stroke Severity
Thrombectomy
Time Factors
Treatment Outcome
United States - epidemiology
title Creation and Validation of a Stroke Scale to Increase Utility of National Inpatient Sample Administrative Data for Clinical Stroke Research
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