RESUMEN
PURPOSE: This study validated incident and recurrent ischemic stroke identified by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) hospital discharge diagnosis codes. METHODS: Using electronic health records (EHR) of adults (≥18 years) receiving care from Kaiser Permanente Southern California with ICD-10 hospital discharge diagnosis codes of ischemic stroke (I63.x, G46.3, and G46.4) between October 2015 and September 2020, we identified 75 patients with both incident and recurrent stroke events (total 150 cases). Two neurologists independently evaluated validity of ICD-10 codes through chart reviews. RESULTS: The positive predictive value (PPV, 95% CI) for incident stroke was 93% (95% CI: 88%, 99%) and the PPV for recurrent stroke was 72% (95% CI: 62%, 82%). The PPV for recurrent stroke improved after applying a gap of 20 days (PPV of 75%; 95% CI: 63%, 87%) or removing hospital admissions related to stroke-related procedures (PPV of 78%; 95% CI: 68%, 88%). CONCLUSION: The ICD-10 hospital discharge diagnosis codes for ischemic stroke showed a high PPV for incident cases, while the PPV for recurrent cases were less optimal. Algorithms to improve the accuracy of ICD-10 codes for recurrent ischemic stroke may be necessary.
Asunto(s)
Prestación Integrada de Atención de Salud , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Adulto , Humanos , Clasificación Internacional de Enfermedades , Alta del Paciente , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Valor Predictivo de las Pruebas , HospitalesRESUMEN
Management of intracranial stenosis remains controversial. Stenting for intracranial stenosis has been associated with high complication and restenosis rates. Morbidity may be related to the intracranial microcatheter exchange that is required in stent placement after the angioplasty. We present a technique in which we deploy an Neuroform Atlas stent through the lumen of a Gateway balloon microcatheter in order to avoid intracranial microcatheter exchange and the associated morbidity. We discuss advantages and pitfalls of this novel technique.
Asunto(s)
Angioplastia de Balón , Procedimientos Endovasculares , Angioplastia , Catéteres , Constricción Patológica , Humanos , Stents , Resultado del TratamientoRESUMEN
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic-associated quarantine has led to a more sedentary lifestyle in teenagers. This may increase the risk for venous thromboembolism and a subsequent source of an ischemic stroke through a patent foramen ovale (PFO). Here, we report a pediatric stroke case likely due to these factors.
