Abstract Details

Title Decreasing Variation in Diagnosis of Transient Ischemic Attack and Ischemic Stroke between Hospitals

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P02 - (-)

Poster/Presentation
Number 020

Objective

Background BACKGROUND: The short duration of symptoms and multitude of non-vascular mimics make diagnosis of TIA subjective and challenging. Pathophysiology is the same for TIA and IS; therefore, the proportion of TIA versus IS should be the same across demographic and clinical strata and theoretically not vary between hospitals.

Design/Methods DESIGN/METHODS: Cases were identified using primary ICD9 discharge codes at three Montefiore hospitals, including a community hospital without neurology residents, from January 2009-June 2011. Each TIA diagnosis was also confirmed by chart review, excluding the diagnosis of TIA in cases with acute IS on brain imaging, duration >24 hours or a non-vascular syndrome by standard criteria. IS diagnosis required an acute infarct on imaging or an explicit statement that the diagnosis was IS despite negative imaging. Mantel-Haenszel chi-square was used for univariate statistical comparison.

Results RESULTS: There were 798 TIA and 2125 IS cases by primary ICD9 code, for an overall TIA-IS ratio of 27.3%. The ratio was highest for the hospital lacking neurology residents (39.2%) versus the two hospitals with neurology residents (26% and 25.2%, p<0.0001). Confirmation of diagnosis by chart review dropped the number of TIA cases by 45%, IS cases by 10%, and decreased the overall TIA-IS ratio to 18.7%. Differences in the ratio between hospitals became non-significant: 19.6% at the hospital lacking neurology residents and 17.4% and 20.4% at the hospitals with neurology residents, p=0.33.

Conclusions CONCLUSIONS: The TIA-IS ratio differs between hospitals; however, retrospective application of simple clinical criteria reduces the differences. Applying commonly accepted criteria can harmonize the way hospitals diagnose and bill for IS and TIA.

Authors/Disclosures
Deepa Bhupali, MD (Home) PRESENTER	Dr. Bhupali has nothing to disclose.
Daniel L. Labovitz, MD	An immediate family member of Dr. Labovitz has received personal compensation for serving as an employee of Herrick Feinstein.
	No disclosure on file
Roberta Lanzillo	Roberta Lanzillo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck, Biogen. Roberta Lanzillo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen, Roche, Novartis.

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