Regional Differences in Thrombectomy Rates
| Autor: | Hans-Ulrich Prokosch, Joachim Berkefeld, Waltraud Pfeilschifter, Thomas Ganslandt, Petar Horki, Eva Neumaier-Probst, Horst Urbach, Christoph Best, Siegfried Bien, Christian Haverkamp, Kristina Szabo, Karl Egger, Marc A. Brockmann, Martin Skalej, Martin Boeker, Manfred Kaps, Wolf-Dirk Niesen, Arnd Dörfler, Stefan Schwab |
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| Rok vydání: | 2018 |
| Předmět: |
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medicine.medical_specialty medicine.medical_treatment Health informatics Brain Ischemia 03 medical and health sciences 0302 clinical medicine Fibrinolytic Agents Mechanical Thrombolysis Germany Humans Medicine Thrombolytic Therapy Radiology Nuclear Medicine and imaging 030212 general & internal medicine Practice Patterns Physicians' Stroke Aged Thrombectomy Neuroradiology Aged 80 and over business.industry Health services research Guideline Thrombolysis Middle Aged medicine.disease Treatment Outcome Tissue Plasminogen Activator Emergency medicine Female Neurology (clinical) Neurosurgery business Medical Informatics 030217 neurology & neurosurgery |
| Zdroj: | Clinical Neuroradiology. 28:225-234 |
| ISSN: | 1869-1447 1869-1439 |
| DOI: | 10.1007/s00062-017-0656-y |
| Popis: | Mechanical thrombectomy, in addition to intravenous (i.v.) thrombolysis is recommended for treatment of acute stroke in patients with large vessel occlusions (LVO) in the anterior circulation up to 6 h after symptom onset. We compared thrombectomy rates of eight university hospitals of the MIRACUM consortium to analyze the implementation of this guideline in clinical routine. Anonymized billing data in a standardized format were loaded into a local i2b2 data warehouse by applying already existing extract, transform and load (ETL) routines. A locally executed uniform SQL (structured query language) query delivered aggregated site data for all inpatients with a discharge diagnosis of ischemic stroke (ICD-10 I63) containing counts for type of acute treatment, type of admission and age groups, which were centrally analyzed with R. From 2014 to 2016, the thrombectomy rate almost doubled from a mean of 4.7% to 9.6%, although significant differences between centers exist (range in 2016: 5.8–17%). The number of drip-and-ship procedures increased in 3 out of 8 centers. There was no evidence for a decrease in thrombectomy rates during weekends/holiday or among patients older than 80 years, but this age group is more likely to receive i.v. recombinant tissue plasminogen activator (rtPA). The observed increase of thrombectomy rates and drip-and-ship procedures without a significant difference between weekdays and weekends or patients of different ages is substantiating a rapid implementation of stroke guidelines within the analyzed neurovascular centers. The prototype of the MIRACUM Data Integration Center already contributes to health services research in Germany. |
| Databáze: | OpenAIRE |
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