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Clinical Neuroradiology

, Volume 28, Issue 2, pp 225–234 | Cite as

Regional Differences in Thrombectomy Rates

Secondary use of Billing Codes in the MIRACUM (Medical Informatics for Research and Care in University Medicine) Consortium
  • Christian HaverkampEmail author
  • Thomas Ganslandt
  • Petar Horki
  • Martin Boeker
  • Arnd Dörfler
  • Stefan Schwab
  • Joachim Berkefeld
  • Waltraud Pfeilschifter
  • Wolf-Dirk Niesen
  • Karl Egger
  • Manfred Kaps
  • Marc A. Brockmann
  • Eva Neumaier-Probst
  • Kristina Szabo
  • Martin Skalej
  • Siegfried Bien
  • Christoph Best
  • Hans-Ulrich Prokosch
  • Horst Urbach
Original Article

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.

Keywords

Data Warehousing Infarction Middle Cerebral Artery Mechanical Thrombolysis Thrombolytic Therapy 

Notes

Acknowledgements

MIRACUM is funded by the German Federal Ministry of Education and Research (BMBF) within the “Medical Informatics Funding Scheme” (FKZ 01ZZ1606H).

Conflict of interest

H. Urbach received honoraria from Stryker. Between July 2014 and July 2017 C. Best received payments as a consultant for Bayer. W. Pfeilschifter received research funding from Stryker Neurovascular for a project of team-based acute stroke workflow optimization. C. Haverkamp, T. Ganslandt, P. Horki, M. Boeker¸ A. Dörfler, S. Schwab, J. Berkefeld, W.-D. Niesen, K. Egger, M. Kaps, M.A. Brockmann, E. Neumaier-Probst, K. Szabo, M. Skalej, S. Bien, H.-U. Prokosch declare that they have no competing interests.

Supplementary material

62_2017_656_MOESM1_ESM.pdf (389 kb)
Online Resource 1 Treatment Overview

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Christian Haverkamp
    • 1
    Email author
  • Thomas Ganslandt
    • 2
  • Petar Horki
    • 3
  • Martin Boeker
    • 3
  • Arnd Dörfler
    • 4
  • Stefan Schwab
    • 5
  • Joachim Berkefeld
    • 6
  • Waltraud Pfeilschifter
    • 7
  • Wolf-Dirk Niesen
    • 8
  • Karl Egger
    • 9
  • Manfred Kaps
    • 10
  • Marc A. Brockmann
    • 11
  • Eva Neumaier-Probst
    • 12
  • Kristina Szabo
    • 13
  • Martin Skalej
    • 14
  • Siegfried Bien
    • 15
  • Christoph Best
    • 16
  • Hans-Ulrich Prokosch
    • 17
  • Horst Urbach
    • 9
  1. 1.Staff Unit IT-Processes, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
  2. 2.Center of Medical Information and Communication TechnologyUniversity Hospital ErlangenErlangenGermany
  3. 3.Center for Medical Biometry and Medical Informatics, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
  4. 4.Department of NeuroradiologyUniversity Erlangen-NürnbergErlangenGermany
  5. 5.Department of NeurologyUniversity Erlangen-NürnbergErlangenGermany
  6. 6.Institute of NeuroradiologyJohann Wolfgang Goethe–UniversityFrankfurtGermany
  7. 7.Department of NeurologyFrankfurt University HospitalFrankfurtGermany
  8. 8.Department of Neurology, Medical CenterUniversity of FreiburgFreiburgGermany
  9. 9.Department of Neuroradiology, Medical CenterUniversity of FreiburgFreiburgGermany
  10. 10.Department of NeurologyJustus-Liebig-University GiessenGiessenGermany
  11. 11.Department of NeuroradiologyUniversity Medical Center MainzMainzGermany
  12. 12.Department of NeuroradiologyUniversity Medical Center MannheimMannheimGermany
  13. 13.Department of NeurologyUniversity Medical Center MannheimMannheimGermany
  14. 14.Institute of NeuroradiologyOtto von Guericke University MagdeburgMagdeburgGermany
  15. 15.Department of NeuroradiologyPhilipps-University MarburgMarburgGermany
  16. 16.Department of NeurologyPhilipps-University MarburgMarburgGermany
  17. 17.Chair of Medical InformaticsFriedrich-Alexander-University Erlangen-NürnbergErlangen-TennenloheGermany

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