Christian Haverkamp1, Thomas Ganslandt2, Petar Horki3, Martin Boeker3, Arnd Dörfler4, Stefan Schwab5, Joachim Berkefeld6, Waltraud Pfeilschifter7, Wolf-Dirk Niesen8, Karl Egger9, Manfred Kaps10, Marc A Brockmann11, Eva Neumaier-Probst12, Kristina Szabo13, Martin Skalej14, Siegfried Bien15, Christoph Best16, Hans-Ulrich Prokosch17, Horst Urbach9. 1. Staff Unit IT-Processes, Faculty of Medicine and Medical Center, University of Freiburg, Agnesenstr. 6-8, 79106, Freiburg, Germany. christian.haverkamp@uniklinik-freiburg.de. 2. Center of Medical Information and Communication Technology, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany. 3. Center for Medical Biometry and Medical Informatics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany. 4. Department of Neuroradiology, University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany. 5. Department of Neurology, University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany. 6. Institute of Neuroradiology, Johann Wolfgang Goethe-University, Schleusenweg 2-16, Haus 95, 60528, Frankfurt, Germany. 7. Department of Neurology, Frankfurt University Hospital, Schleusenweg 2-16, Haus 95, 60528, Frankfurt, Germany. 8. Department of Neurology, Medical Center, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany. 9. Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany. 10. Department of Neurology, Justus-Liebig-University Giessen, Klinikstraße 33, 35385, Giessen, Germany. 11. Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55101, Mainz, Germany. 12. Department of Neuroradiology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. 13. Department of Neurology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. 14. Institute of Neuroradiology, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. 15. Department of Neuroradiology, Philipps-University Marburg, Baldingerstr. 1, 35043, Marburg, Germany. 16. Department of Neurology, Philipps-University Marburg, Baldingerstr. 1, 35043, Marburg, Germany. 17. Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Wetterkreuz 13, 91058, Erlangen-Tennenlohe, Germany.
Abstract
BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
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