Risultati per: Passo 10. Intervenire sul singolo paziente in visita: GPG Patient

Stroke, Volume 56, Issue Suppl_1, Page ATP124-ATP124, February 1, 2025. Value-based medicine places the patient and their health status at the center of the intervention through the use of Patient-Reported Outcome Measures (PROMs). The ideal would be that these outcome measurements were answered directly by the patient but in many cases it is a caregiver or a healthcare professional who collects the person’s health status perception. This reason could lead to a bias in the results.Our aim was to compare whether there were differences in the perception of health status depending on who answered these questionnaires.Stroke patients discharged from six European hospitals were included in a 1-year follow-up program based on a holistic communication tool (web platform for professionals and app for patients/caregivers) called NORA. PROMs at 7-90 days were collected through NORA-app. In case that the patient or caregiver didn’t have access to a smartphone, the data collection was carried out by a professional healthcare who contacted them to manage PROMs by a phone call.Main outcome measures include: HAD-depression and HAD-anxiety (defined as pathological by a score ≥10 points in each of the subscales) and PROMIS-10 (cut-offs raws values of normality were defined as: Physical-PROMIS >13 and Mental-PROMIS >11). Median scores per collector were compared. In addition, a social questionnaire was collected from app-users’.Over two years, 5116 stroke patients were included in Harmonics project, 60% were men with a mean age of 70.2 years and median mRS of 2(1- 3) at hospital discharge. From them, 2432 were actively monitored and 1498 reported PROMs (428 patients (28.6%), 376 (25.1%) caregivers and 694 (46.3%) professionals). P-value < 0.05 was considered significant for all tests at 90 days. Median PROMs results are shown in Table-1.The social questionnaire (Figure-1) showed significant differences between male and female patients. From the total, 26.6% women and 11.7% men leave alone (p-value = 0.005).At the patients group 77.9% women considered they can take care of their basic needs’ vs 85.9% men (p-value= 0.036).Significant differences were found between the three groups of collectors, with professionals being the ones who perceive a better state of patient health through the collected PROMs collected. Among patients and caregivers groups, worse outcomes were reported by the last one.When using PROMs the collector should avoid bias in reporting the results and direct patient response should be encouraged.

Stroke, Volume 56, Issue Suppl_1, Page ATP116-ATP116, February 1, 2025. Background and aims:Conventional approaches for stroke rehabilitation primarily involve static muscle strengthening exercises, weight bearing and shifting by therapists. Robot-assisted gait training facilitates the learning of reproducible symmetric gait patterns and reduces expenditure. The GTR-A (HUCASYSTEM, Korea), a robotic gait rehabilitation device for both upper and lower limbs, utilizes end-effector-based movement and provides training to enhance gait function. In this study, we aim to elucidate the clinical efficacy of rehabilitation therapy using GTR-A in subacute/chronic stroke patients.Methods:This study was a prospective, randomized, controlled clinical trial. There were 14 participants in total, with 7 in each of the experimental and control groups (table. 1). The gait abilities were evaluated using the berg balance scale (BBS), 6-minute walk test (6MWT) and cardiopulmonary exercise testing. Over period of 4 weeks, the experimental group underwent 10 sessions of robot-assisted rehabilitation for 30minutes/day, 3times/week in addition to conventional physical therapy for 30min/day, 5times/week. The control group received 10 sessions of only conventional physical therapy for 60minutes/day, 5times/week.Results:In the experimental group, significant improvements were observed in both BBS and 6MWT. However, there was no significant increase in maximal oxygen consumption. In contrast, the control group did not show significant functional improvements (table. 2).Conclusion:The combination of conventional rehabilitation therapy and robotic gait training using GTR-A showed superior outcomes in the recovery of gait function compared to conventional therapy alone.

Stroke, Volume 56, Issue Suppl_1, Page ADP9-ADP9, February 1, 2025. Background:Stroke is the fifth leading cause of death in Minnesota and in the United States. Stroke is a leading cause of long-term disabilities and is largely preventable (80%). Evidence indicates that patients receiving care from stroke specialized nurses, including nurse-led stroke prevention, show better outcomes. Stroke program leaders at a Primary Stroke Center identified this as an opportunity to improve stroke program education, quality of nursing care, and stroke patient outcomes.Purpose:The primary focus area was improving stroke-patient education to include individualized stroke risk factors. As our project progressed, the initial goal remained. The secondary focus was to see if the effect of in-person, hands-on (escape room) nurse education would improve individualized stroke-patient education compliance compared to eLearning and poster board education.Methods:All stroke cases from June 2023 – June 2024 were audited for documentation of individualized stroke-patient education. Utilizing stroke guidelines and scientific statements, a standardized practice of individualizing stroke-patient education was developed. Staff learning modules were developed including eLearning, unit poster board, and in-person learning (escape room). Throughout the project, completion rates of individualized stroke-patient education were compared. A nursing survey was conducted to evaluate confidence and knowledge post multimodality learning modules.Results:Prior to initiation of nursing learning modules, 24 hospitalized stroke-patient charts from June and July 2023 were audited for individualized stroke education (40%). After initiation of nursing learning modules, 183 hospitalized stroke-patient charts from August 2023 to June 2024 were audited for individualized stroke education (poster board 44%, eLearning 45%, escape room 75%). The post nursing learning module survey responses demonstrated improved learners’ knowledge for the interactive escape room (poster board average-good 77%, eLearning average-good 83%, escape room good-excellent 89%).Conclusion:By identifying educational gaps, we were able to enhance nursing education; which improved stroke-patient education and outcomes. In conclusion, nursing confidence and knowledge increased with the in-person escape room education. This suggests engaging in-person learning could be more effective in developing nursing knowledge, improving patient care, and positive patient outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATP126-ATP126, February 1, 2025. Background:Stroke survivors face functional changes that may alter their quality of life. Although these changes are significant for the stroke survivor, they are consequential for the caregiver of the stroke patient as well. Psychological burden of stroke caregivers has been investigated, but its association with level of disability and quality of life of the stroke patient has been less studied.Objective:To determine if worse 90-day patient stroke outcomes result in greater caregiver strain and worse caregiver mental health in a multiethnic sample.Methods:Using data from the Brain Attack Surveillance in Corpus Christi project, we prospectively determined 90-day ischemic and hemorrhagic stroke outcome from 2019-2023. Patient function based on ADLs/IADLs (higher scores worse) along with patient quality of life based on SS-QOL (higher scores better) were used to measure patient outcome. Stroke caregivers’ depression was measured using the PHQ-8 (higher scores worse) and strain was measured by mCSI (higher scores worse). Generalized propensity scores (GPS) were calculated for the main exposures using caregiver and patient demographics, dyad characteristics, and clinical variables as predictors. Caregiver outcomes were modeled with linear regression, with caregiver depression and strain as main outcomes, unadjusted and adjusted for GPS.Results:During this time period, 339 strokes were identified and their caregivers subsequently interviewed. The median age of interviewed caregivers was 55, with 46% being the sole informal caregiver. A majority of the caregivers interviewed were either the spouse of the stroke patient (42.2%) or the child of the stroke patient (38.1%). In adjusted analyses, functional status for stroke patients was not associated with caregiver depression (p=0.12), higher stroke patient quality of life was strongly associated with lower odds of any depression symptoms among caregivers (p

Stroke, Volume 56, Issue Suppl_1, Page ATP372-ATP372, February 1, 2025. Introduction:Ischemic stroke is highly heterogeneous, with patient-to-patient differences in infarct location, severity, and degree of reperfusion, among other factors. Incorporating this variability in preclinical stroke models is useful to more comprehensively recapitulate the patient population. Prior studies employ Longa (complete reperfusion) or Koizumi (chronic hyporeperfusion) murine models of stroke interchangeably over a range of ischemic durations. These models represent distinct stroke phenotypes, but the unique features of each model warrant further definition. Therefore, we sought to differentiate the pathology of these models to more accurately model patient heterogeneity.Methods:Transgenic mice expressing a fluorescent neutrophil marker (Ly6G-TdTomato) were subject to the Longa or Koizumi temporary middle cerebral artery occlusion (tMCAO) model of ischemic stroke. Ischemic duration was varied to model strokes of mild (30 min), moderate (60 min) and high (90 min) severity (n = 6-10 per experimental model). Laser speckle contrast imaging (LSCI) was performed at baseline, prior to and after reperfusion, and at endpoint to quantify cerebral blood flow (CBF) using a custom-made pixel assignment algorithm. Brains were collected at 24h or 72h and imaged via confocal microscopy to evaluate neutrophil infiltration in the ischemic hemisphere.Results:Mortality significantly increased with ischemic duration in the Koizumi model at 24h, 48h, and 72h, but did not differ across the Longa models. LSCI demonstrated a 2-to-5-fold increase in the area of profound ischemia (lowest quintile of pixel values) in the Koizumi model compared to the Longa model and with increasing ischemic duration. Additionally, the Koizumi model exhibited less restoration of CBF following reperfusion and more variability in CBF within the ischemic hemisphere regardless of ischemic duration. The number of infiltrating neutrophils increased 10-fold between the 30- and 90-min Longa and Koizumi models, but the Koizumi model demonstrated increased variability in the number of neutrophils at 24h and 72h.Conclusions:Our findings demonstrate differences in mortality, CBF, and immune response between stroke models of varying ischemic duration and reperfusion status. These unique pathological features can be linked to the physiological perturbations defining each model to establish a phenotypic spectrum that can be exploited to more thoroughly represent human stroke patient heterogeneity.

Stroke, Volume 56, Issue Suppl_1, Page A66-A66, February 1, 2025. Introduction:Many patients may not recognize the initial symptoms of TIA or stroke and delay seeking urgent medical care, leading to missed treatments and worse outcomes. Diagnostic decision support (DDSS) systems may help these patients recognize and act on early symptoms of stroke or TIA. Large language models (LLMs) are available and utilized by the public. We evaluated the efficacy of GPT 4.o, a recent LLM, for the prediction of stroke or TIA from data collected at presentation among patients admitted to an emergency department TIA/Stroke observational unit (ED-OU).Methods:1466 patients admitted to the ED-OU for suspected TIA in a large, urban, academic ED, from 3/2013 – 2/2020 were included. A thorough history and physical were obtained, including presenting symptoms, symptom time course, vital signs, and past medical history. The outcome was a discharge diagnosis of stroke, TIA, or an alternate diagnosis, from a consulting neurologist and confirmed with neuroimaging. For a random sample of 500 records demographics and symptom data were entered into GPT 4.o via OpenAI’s Application Programming Interface (API). We used a validated prompt that requests the 5 most likely diagnoses. The sensitivity of the GPT 4.o diagnoses for the neurologist’s diagnosis was calculated as a match in the top 1 (M1), top 3 (M3) or top 5 (M5). Sensitivity to a combined diagnosis of TIA or stroke was also calculated. Results were compared to (1) a random sample of 100 patients from the same dataset manually entered into the ChatGPT4.o interface by a research assistant, and (2) results from evaluation of ChatGPT 4.0 with data from a study of patients requesting urgent primary care, who entered their clinical data into a DDSS app.Results:The 500 cases included 257 with TIA, 73 with stroke, and 170 with other diagnoses. Table 1 shows results of diagnostic matches. Diagnostic lists of 18.4% of cases had no match between GPT4.o and the neurologist’s diagnosis. 5.4% of cases had no clear neurologist diagnosis. GPT4 sensitivity just for combined diagnosis of TIA or Stroke was 98.8%.Conclusions:DDSS like ChatGPT/GPT4.o have potential to aid patients’ prompt recognition of TIA or stroke symptoms which could shorten time to care. To better define usability, accuracy and safety of DDSS, we are studying direct data collection from patients in the ED or urgent primary care, including stroke patients or their companions, and evaluating other DDSS tools including symptom checkers.

Stroke, Volume 56, Issue Suppl_1, Page A10-A10, February 1, 2025. Introduction:CTP is used to distinguish core infarct from penumbral tissue in the 6-24 hour time window from last known well time (LKW). In addition, routine use of CTP inside of 6 hours may increase the sensitivity of detecting medium vessel occlusion (MeVO) as compared with CTA alone. Therefore, some centers apply a strategy of using CTP/CTA routinely in the first 6 hours from LKW while others reserve CTP for the 6-24 hour delayed time window. We hypothesized that use of CTP/CTA inside of 6 hours from LKW is associated with increased EVT especially for MeVO.Methods:This is a retrospective analysis of acute ischemic stroke (AIS) patients from a multi-state stroke registry between Jan 2018 and Mar 2024 who presented within 6 hours of LKW. The incidence of EVT by triage imaging modality (CTA or CTA/CTP) was analyzed overall and also by occlusion location (Large vessel occlusion (LVO), MeVO) through linear mixed models (LMM). Multivariable models were used to adjust for confounding factors. A two-tailed p value of

Stroke, Volume 56, Issue Suppl_1, Page A73-A73, February 1, 2025. Introduction:The American Stroke Association goals for Target: Stroke – Phase III include achieving a door to device (DTD) of 90 minutes or less for direct arriving patients in at least 50% of patients who undergo endovascular thrombectomy (EVT) or acute ischemic stroke patients with large vessel occlusion (LVO). While it is generally held that faster reperfusion is associated with better patient outcomes, the magnitude of benefit in achieving the goal of DTD

Stroke, Volume 56, Issue Suppl_1, Page ATP136-ATP136, February 1, 2025. Background:The STRACK project aims to improve post-stroke patient management and the transition from acute to primary care thanks to improvements in patient pathways and monitoring cardiovascular risk factors: heart failure, diabetes, atrial fibrillation, dyslipidemia and hypertension. Collaboration between primary care centers and hospital staff was essential for the project’s success by delivering personalized care and home monitoring devices to patients through access to a digital platform. STRACK was launched with a european value-based contracting process and Roche Diag. as partner.Methods:The three-year project was launched in May 2021, during first year all specialties and professionals participated in the development and planning of the project and were trained in the use of the devices and own digital platform.First STRACK patient was enrolled in May 2022. Once these post-stroke patients have been identified, they are given a personalized monitoring plan depending on the individuals’ risk factors, the personalized care and rehabilitation plans are tracked and followed. For a year post-discharge, a nursing and administrative team follows the data that the patient enters remotely or is automatically available on their mobile application.Results:STRACK has evolved the continuum of care by 421patient in July 2024 and ongoing, by integrating comprehensive monitoring of cardiometabolic risk factors (heart failure, diabetes, atrial fibrillation, dyslipidemia, hypertension) into a patient discharge plan, identified as key to avoiding stroke recurrence and improving control of vascular risk factors are monitored.Preliminary results of 231 patients (May 2022-2023) with full one year follow-up comparing with historical cohort (May 2018-2019) showed: Reduction in unnecessary visits (weighted): -26,3%. Reduction in admissions for stroke recurrence or related to stroke, (heart attack, angina, peripheral embolism, etc.): Stroke, 30days: -100%; Related to stroke, (365d: -47,7%; 30d: -57,0%). Reduction in cardiovascular admissions ( 30d: -100%; 365d: -31,4%). Best treatment adherence: 81,2% (72% previously)Conclusion:The great value of STRACK is knowing the evolution of stroke patients post-discharge through strict self-monitoring of clinical parameters, following prior health education. STRACK has managed to achieve reduction in stroke recurrence and adverse events and readmissions for cardiovascular risk factors, reducing emergency visits for vascular events.

Stroke, Volume 56, Issue Suppl_1, Page AWMP6-AWMP6, February 1, 2025. Introduction:Many centers have opted to make the transition from alteplase to tenecteplase over the past three years. Making major treatment changes in a healthcare setting has its challenges. This transition period gave us a unique opportunity to assess patient outcomes comparing both drugs with the same healthcare system with similar patient populations.Hypothesis:Patients who received tenecteplase will have shorter door-to-needle (DTN) times and better outcomes as measured by 90-day Modified Rankin Scores (mRS) with no significant increase in symptomatic ICH (sICH) when compared to patients who received alteplase.Methods:Differences between continuous variables were analyzed using the student’s t-test and Wilcoxon rank test, and the chi-squared test for categorical variables. The primary independent variable was the binary group (tenecteplase vs. alteplase). A generalized linear model was built for the outcome DTN and logistic regression model for the binary outcome (mRS ≤2 as good, >2 as poor) controlling for demographics, comorbidities, NIHSS, LKW time and ICH admission. Odds ratios (OR) and 95% confidence intervals (CI) were reported, with all analyses performed in R v4.4.1.Results:The dataset was extracted from the HDSA (with a HOPES registry subgroup), including 574 patients—323 in the alteplase group and 251 in the tenecteplase group. The mean age was similar between groups (66.06 vs. 65.9 years; P=0.88), as was the mean DTN (46.9 vs. 48.9 minutes; P=0.11). A multivariable generalized linear model, adjusted for demographics and comorbidities, showed no significant difference in DTN between the groups (Δβ = -3.04 [95% CI -8.33 to 2.25]; P=0.26). However, in a subgroup analysis looking at the HOPES registry from a single center, a multivariable logistic regression, also adjusted for demographics and comorbidities, indicated that patients in tenecteplase had lower odds of poor functional outcomes at 90 days compared to alteplase (OR = 0.11 [95% CI 0.01–0.84]; P=0.03).Conclusion:While DTN times did not improve with the transition to tenecteplase, we do see that patients who received tenecteplase were less likely to have poor outcomes as defined by an mRS of 3-6 based on our subgroup analysis. The rate of sICH was also comparable between the two groups. Additional post-implementation studies should be considered to assess trends in mRS outcomes as more stroke centers transition to use of tenecteplase in acute ischemic stroke.

Stroke, Volume 56, Issue Suppl_1, Page ATP172-ATP172, February 1, 2025. Introduction:The 2021 AHA/ASA Scientific Statement on Retinal Artery Occlusion (RAO) indicated treatment with thrombolytics may be effective and systems should prioritize its early recognition. We describe the phased deployment of fundus cameras across 10 Emergency Departments (EDs) in a southern California health system for emergent visualization and diagnosis of monocular vision loss.Methods:Program Development:In 2022, Vascular Neurology, ED and Ophthalmology initiated discussions to deploy fundus cameras to support emergent diagnosis of monocular vision loss. The fundus camera image ordering was integrated with the electronic medical record (EMR). Department leaders socialized the program with training sessions and job aids.Operational Scope:Any medical professional working in the ED was permitted to operate the device. A small group of “superusers” were identified at each medical center to obtain competency in camera operation. In-person training sessions for ED physicians/staff covered order placement, image capture and transmission, troubleshooting and device maintenance.Acute Vision Loss Workflow:Patients presenting with monocular vision loss within 4.5 hours of last known well time follow the code stroke algorithm predicated on BEFAST symptoms. A stat CTH is obtained, followed by a teleneurologist examination. If patient presents with only monocular vision loss, a fundus photo is captured and remotely emergently interpreted by an ophthalmologist. If photo is consistent with an RAO, thrombolysis is offered.Results:From July 2022 to June 2024, 1079 fundus photos were obtained across 10 stroke centers. The mean age (SD) was 55.9yrs (17.6). The percent female was 55%. The racial/ethnic breakdown of individuals who had a fundus photo was 32.4% White, 14.5% Black, 12.1% Asian, 7.9% Other and 33% Hispanic. 27 (2.5%) of patients were diagnosed with RAO, out of which 4 patients received thrombolytics. Non-thrombolytic patients were given antiplatelets and admitted for further assessment of RAO etiology. Those who did not receive thrombolytics were all outside of the 4.5-hour time to treat. 26 (2.5%) had a final diagnosis of a cerebral ischemic stroke.Conclusion:Fundus camera deployment for the assessment of acute monocular vision loss improves management of RAO patients with thrombolytics and/or allows further assessment of the etiology in a more urgent manner.

Stroke, Volume 56, Issue Suppl_1, Page AWP75-AWP75, February 1, 2025. Background and Issues:Timely diagnosis and treatment are essential for optimal outcomes in acute stroke care. The lack of EMS integration into the stroke system of care is leading to delays in treatment resulting in poor outcomes. The absence of centralized resources at the Comprehensive Stroke Center (CSC) results in delayed patient care and worsened outcomes.Purpose:This project aimed to enhance EMS stroke recognition and improve triage to appropriate stroke centers, thereby reducing treatment times. The successful integration of EMS with an optimized CSC triage protocol seeks to reduce hospital stays, mortality rates, direct costs, and long term disability.Method:Effective integration of EMS into the stroke system of care was achieved by developing triage protocols with local EMS leaders. Adoption of a standardized stroke triage assessment tool was implemented. Centralizing resources at the CSC was a multidisciplinary approach to streamline the identification and treatment of stroke patients in a definitive location near CT scan. Stroke triage education and mock drills were provided to local EMS agencies and the acute stroke team. Outcomes were measured using pre and post intervention data for TNK administrations and endovascular therapy.Results:Outcomes were measured in two groups of acute stroke patients who received TNK, mechanical thrombectomy, or both. 115 patients from 2022 prior to project initiation and 131 patients from 2023 after its initiation. TNK door-to-needle time decreased from 37 to 32 minutes. Thrombectomy door-to-revascularization time dropped from 118 to 85 minutes. Average hospital stay reduced from 8 to 7 days. Mortality rates fell from 13.04% to 3.94%. Direct costs decreased from $27,989 to $24,109. Thrombectomy mortality decreased from 17.14% to 6.06%. 90-day modified Rankin score 2 or less improved from 45% to 49%. Average EMS first contact to revascularization went from 152 minutes to 120 minutes. Average EMS first contact to TNK administration went from 70 minutes to 67 minutes.Conclusion:The implementation of standardized EMS triage protocols and centralized resources at the CSC led to significant improvements in acute stroke care. The interventions resulted in faster treatment times, reduced hospital days, lower mortality rates, decrease in direct costs, and improved long-term functional outcomes. These findings highlight the significance of EMS integration and resource centralization to improve patient outcomes.

Stroke, Volume 56, Issue Suppl_1, Page A154-A154, February 1, 2025. Background:The direct medical costs of stroke in the United States were $84.4 billion in 2012 and were projected to rise by 157% to $217.3 billion by 2030. However, the 10-year trend in inpatient stroke care costs under Medicare, as well as the Medicare payment variation across different states, has yet to be thoroughly investigated.Methods:This is a retrospective analysis of the 2013 to 2022 Medicare Inpatient Hospitals – by Provider and Service Data that provides inpatient hospital charges by Medicare Severity Diagnosis Related Group (DRG) in stroke admission (DRG: 61-66). Percentage change in stroke admission cost adjusted for healthcare inflation between 2013-14 to 2021-22 weighted for the number in each stroke DRG was included in the analysis.Results:Between 2013 and 2022, nationwide there were a total of 2,007,005 unique stroke-related inpatient hospital claims, resulting in Medicare payments totaling $21.07 billion from the Medicare Services. In 2013, the mean Medicare payment, weighted per stroke DRG for each stroke admission, was $9,486.08 (95% CI: $9,448.98–$9,523.18) nationwide. By 2022, after adjusting for healthcare inflation, the mean Medicare payment, weighted per stroke DRG, increased to $10,047.34 (95% CI: $9,994.39–$10,100.30) nationwide (Figure 1). At the state level, the 10-year analysis of Medicare payment for stroke admissions revealed a 33% decrease in payment costs in Vermont, while Maryland experienced the highest increase, with a 23% rise in Medicare payment costs (Figure 2).Conclusion:Nationwide, the overall Medicare payment for stroke-related DRG costs has increased by over $560 in the past decade after adjusting for healthcare inflation and weighted per-stroke DRGs. However, at the state level, certain states have experienced a reduction in Medicare payments for stroke admissions.

Stroke, Volume 56, Issue Suppl_1, Page AHUP20-AHUP20, February 1, 2025. Background:In Los Angeles County, the impact of high social vulnerability on stroke patient outcomes is a critical area of concern, given the region’s diverse socioeconomic landscape and significant health disparities. High social vulnerability among stroke patients can significantly impact their outcomes in several ways, from poorer functional outcomes, access to care, and higher risk for pre-existing conditions, including increased history of behavioral health issues.Objective:This study aims to explore how high social vulnerability affects stroke outcomes among patients in Los Angeles County Health System, pre-existing co-morbidities, recovery trajectories, and overall health status. And evaluate differences between race, gender and age.Methods:We conducted a social vulnerability index analysis of stroke patients in the Los Angeles County Health System, utilizing data from medical records, socioeconomic indicators, and healthcare access metrics. Social vulnerability was assessed using indices incorporating factors such as income, education, housing stability, and access to healthcare.Results:Findings reveal that stroke patients with high social vulnerability experience poorer functional outcomes (p

Stroke, Volume 56, Issue Suppl_1, Page AWMP36-AWMP36, February 1, 2025. Introduction:ICD-10 codes are often used for stroke research in administrative databases. Few studies have assessed their reliability in large, representative populations of the United States. We validated ICD-10 codes in a large population-based study of stroke in the Greater Cincinnati/Northern Kentucky (GCNK) region.Methods:We ascertained all acute strokes in the GCNK region during 2020 using validated methodology. All hospitalizations were screened using a comprehensive list of ICD codes in any diagnosis position (G45-46/H34/I60-69). Additional cases were captured through cold pursuit. Each case was adjudicated by a stroke-trained physician. Only acute ischemic stroke (AIS) and hemorrhagic strokes (HS, defined as intracerebral hemorrhage or subarachnoid hemorrhage) were included in this analysis. We examined how many AIS cases were identified using the standard codes used for administrative studies (G46/I63), assessing their sensitivity and positive predictive value (PPV) in the primary or secondary positions. A similar analysis was conducted using standard HS codes (I60/I61). Differences in the demographics of cases identified with standard codes in the primary position, standard codes in the secondary position, or through other methods were then evaluated with Chi-squared and Kruskal-Wallis tests.Results:We identified 3,522 AIS/HS events in 2020. For AIS (Table 1), we found that standard codes in the primary position had a sensitivity of 72.8% and a PPV of 89.1%. When the standard AIS codes were considered in any diagnosis position, sensitivity improved to 89.3%, but PPV decreased to 82.3%. For HS, standard codes in the primary position had a sensitivity of 80.0% and a PPV of 81.0%. When the standard HS codes were considered in any position, the sensitivity improved to 93.4% but the PPV decreased to 54.4%. When looking at baseline characteristics (Table 2), patients identified through a standard code in the primary position had a lower baseline mRS (overall P

Stroke, Volume 56, Issue Suppl_1, Page AWMP57-AWMP57, February 1, 2025. Background:The vascular region of a stroke is reported in International Classification of Diseases-10 (ICD10) subcodes as either a specific or nonspecific/unspecified location. The coding has been shown to be accurate for specific ischemic stroke regions but has not been assessed for nonspecific/unspecified coding. The overall accuracy has implications for research. We aimed to describe the imaging characteristics in strokes coded with nonspecific/unspecified region subcodes and to assess for associations with their use.Methods:From a single comprehensive stroke center, we randomly selected 200 stroke hospitalizations with a primary discharge I63 ICD10 code; 100 had non-specific/unspecified vascular location subcodes, and 100 had specific vascular location subcodes oversampled for posterior circulation strokes. Gold-standard scoring of the vascular region was performed using the imaging studies and reports blinded to the subcode. The NIHSS was categorized using R29 codes (i.e. missing, mild, moderate, severe). We used logistic regression to assess the association of potential predictors with nonspecific/unspecified ICD10 vascular region subcodes weighted for the sampling.Results:In the 100 strokes with nonspecific/unspecified region subcodes, mean NIHSS was 4.0 (SD 4.2), 88% had a head CT and 93% had a MRI. The most commonly used non-specific/unspecified codes were I63.9 (48%), I63.89 (20%), and I63.81 (11%). The gold standard classification of vascular region identified an acute infarct in a defined location in 85 of the 100 cases that had non-specific/unspecified subcodes: 45 anterior circulation strokes (27 MCA, 9 ACA , 9 carotid), 40 posterior circulation strokes (17 PCA, 11 basilar, 6 cerebellar, 6 vertebral), and 15 with no infarct on imaging. In the model (c-statistic 0.63), NIHSS category (severe stroke vs missing: OR 0.08; 95% CI:0.01-0.49), no gold standard acute lesion (OR 10.8; 95% CI:1.0-115.9), and MRI performed (OR 3.25; 95% CI:1.0-10.4) were associated with nonspecific/unspecified ICD10 subcodes but posterior versus anterior circulation location of infarct was not (OR 0.88; 95% CI: 0.41-1.8).Conclusions:We found that most stroke hospitalizations with a nonspecific/unspecified vascular region subcode have acute lesions of a specific region on imaging and were more likely to have low NIHSS. These findings suggest that selecting for specific stroke locations based on ICD10 codes could bias studies toward more severe strokes in that region.