[Diagnosis related groups in stroke treatment. An analysis from the stroke data bank of the German Stroke Foundation]. / Fallpauschalen in der Schlaganfall-Behandlung - Erkenntnisse aus der Schlaganfall-Datenbank der Stiftung Deutsche Schlaganfall-Hilfe -

BACKGROUND: The upcoming introduction of diagnosis related groups (DRG) as an exclusive base for future calculation of hospital proceeds in Germany requires a thorough analysis of cost data for various diseases. OBJECTIVE: To compare the resulting combined cost weights of the Australian Refined DRG system (AR-DRG) with the proceeds based on actual per-day rates in stroke treatment. PATIENTS AND METHODS: Between 1998 and 1999, data from 6520 patients (median age 68 years, 43% women) with acute stroke or transient ischemic attack (TIA) were prospectively documented in 15 departments of Neurology with an acute stroke unit, 9 departments of general Neurology and 6 departments of Internal Medicine. Prior to grouping cases into DRGs, all available data were transferred into ICD-10-SGB-V 2.0 or the Australian procedure system (MBS-Extended). Hospital proceeds for the respective cases were calculated based on per-day rates of the documenting hospitals. RESULTS: The resulting cost weights demonstrate a good homogeneity compared to the length of stay. When introducing the AR-DRG with a uniform base rate in Germany, a relative decrease of hospital proceeds can be expected in Neurology Departments and for treatment of TIAs. CONCLUSION: Preservation of the existing structure of acute stroke care in Germany requires a supplement to a uniform base rate in Neurology departments.

A computed tomography score for assessment of mass effect in space-occupying cerebellar infarction.

BACKGROUND AND PURPOSE: Patients with cerebellar infarction are threatened by infratentorial herniation and impaired circulation of cerebrospinal fluid if mass effect in posterior fossa develops. Clinical assessment is often impaired in patients with disturbances of consciousness. Therefore, computed tomography (CT) examination is essential in the diagnosis of complication and decision for operative treatment. METHODS: Mass effect of cerebellar infarction was quantitatively assessed using a 3-item CT score: width of fourth ventricle, compression of quadrigeminal cistern, and width of lateral ventricle. Retest and interrater reliability was determined. Validity of assessment of mass effect was examined using 185 CT scans from a cerebellar infarction study, and the effect of operative treatment on CT score was determined. RESULTS: The correlation coefficients for retest and interrater reliability were 0.94 and 0.75, respectively. The authors found a significant difference for the CT sum score and all CT items except "compression of the fourth ventricle" between patients with different levels of consciousness. Effect of operative treatment was documented by improvement of CT score. CONCLUSIONS: The proposed CT score is of high interrater and retest reliability, supplements the clinical assessment of the patient, and is able to monitor the efficacy of decompressive treatment.