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Validation of Carotid Artery Revascularization Coding in Ontario Health Administrative Databases

Hussain, Mohamad A; Mamdani, Muhammad; Saposnik, Gustavo; Tu, Jack V; Turkel-Parrella, David; Spears, Julian; Al-Omran, Mohammed
PURPOSE: The positive predictive value (PPV) of carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedure and post-operative complication coding were assessed in Ontario health administrative databases. METHODS: Between 1 April 2002 and 31 March 2014, a random sample of 428 patients were identified using Canadian Classification of Health Intervention (CCI) procedure codes and Ontario Health Insurance Plan (OHIP) billing codes from administrative data. A blinded chart review was conducted at two high-volume vascular centers to assess the level of agreement between the administrative records and the corresponding patients' hospital charts. PPV was calculated with 95% confidence intervals (CIs) to estimate the validity of CEA and CAS coding, utilizing hospital charts as the gold standard. Sensitivity of CEA and CAS coding were also assessed by linking two independent databases of 540 CEA-treated patients (Ontario Stroke Registry) and 140 CAS-treated patients (single-center CAS database) to administrative records. RESULTS: PPV for CEA ranged from 99% to 100% and sensitivity ranged from 81.5% to 89.6% using CCI and OHIP codes. A CCI code with a PPV of 87% (95% CI, 78.8-92.9) and sensitivity of 92.9% (95% CI, 87.4-96.1) in identifying CAS was also identified. PPV for post-admission complication diagnosis coding was 71.4% (95% CI, 53.7-85.4) for stroke/transient ischemic attack, and 82.4% (95% CI, 56.6-96.2) for myocardial infarction. CONCLUSIONS: Our analysis demonstrated that the codes used in administrative databases accurately identify CEA and CAS-treated patients. Researchers can confidently use administrative data to conduct population-based studies of CEA and CAS.
PMID: 27040863
ISSN: 1488-2353
CID: 2116772

The VASOGRADE: A Simple Grading Scale for Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

de Oliveira Manoel, Airton Leonardo; Jaja, Blessing N; Germans, Menno R; Yan, Han; Qian, Winnie; Kouzmina, Ekaterina; Marotta, Tom R; Turkel-Parrella, David; Schweizer, Tom A; Macdonald, R Loch
BACKGROUND AND PURPOSE: Patients are classically at risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage. We validated a grading scale-the VASOGRADE-for prediction of DCI. METHODS: We used data of 3 phase II randomized clinical trials and a single hospital series to assess the relationship between the VASOGRADE and DCI. The VASOGRADE derived from previously published risk charts and consists of 3 categories: VASOGRADE-Green (modified Fisher scale 1 or 2 and World Federation of Neurosurgical Societies scale [WFNS] 1 or 2); VASOGRADE-Yellow (modified Fisher 3 or 4 and WFNS 1-3); and VASOGRADE-Red (WFNS 4 or 5, irrespective of modified Fisher grade). The relation between the VASOGRADE and DCI was assessed by logistic regression models. The predictive accuracy of the VASOGRADE was assessed by receiver operating characteristics curve and calibration plots. RESULTS: In a cohort of 746 patients, the VASOGRADE significantly predicted DCI (P<0.001). The VASOGRADE-Yellow had a tendency for increased risk for DCI (odds ratio [OR], 1.31; 95% CI, 0.77-2.23) when compared with VASOGRADE-Green; those with VASOGRADE-Red had a 3-fold higher risk of DCI (OR, 3.19; 95% CI, 2.07-4.50). Studies were not a significant confounding factor between the VASOGRADE and DCI. The VASOGRADE had an adequate discrimination for prediction of DCI (area under the receiver operating characteristics curve=0.63) and good calibration. CONCLUSIONS: The VASOGRADE results validated previously published risk charts in a large and diverse sample of subarachnoid hemorrhage patients, which allows DCI risk stratification on presentation after subarachnoid hemorrhage. It could help to select patients at high risk of DCI, as well as standardize treatment protocols and research studies.
PMID: 25977276
ISSN: 1524-4628
CID: 2116782

Managing aneurysmal subarachnoid hemorrhage: It takes a team

de Oliveira Manoel, Airton Leonardo; Turkel-Parrella, David; Duggal, Abhijit; Murphy, Amanda; McCredie, Victoria; Marotta, Thomas R
Patients with aneurysmal subarachnoid hemorrhage are at high risk of complications, including rebleeding, delayed cerebral ischemia, cerebral infarction, and death. This review presents a practical approach for managing this condition and its complications.
PMID: 25932743
ISSN: 1939-2869
CID: 2116792

Aneurysmal subarachnoid haemorrhage from a neuroimaging perspective

de Oliveira Manoel, Airton Leonardo; Mansur, Ann; Murphy, Amanda; Turkel-Parrella, David; Macdonald, Matt; Macdonald, R Loch; Montanera, Walter; Marotta, Thomas R; Bharatha, Aditya; Effendi, Khaled; Schweizer, Tom A
Neuroimaging is a key element in the management of patients suffering from subarachnoid haemorrhage (SAH). In this article, we review the current literature to provide a summary of the existing neuroimaging methods available in clinical practice. Noncontrast computed tomography is highly sensitive in detecting subarachnoid blood, especially within 6 hours of haemorrhage. However, lumbar puncture should follow a negative noncontrast computed tomography scan in patients with symptoms suspicious of SAH. Computed tomography angiography is slowly replacing digital subtraction angiography as the first-line technique for the diagnosis and treatment planning of cerebral aneurysms, but digital subtraction angiography is still required in patients with diffuse SAH and negative initial computed tomography angiography. Delayed cerebral ischaemia is a common and serious complication after SAH. The modern concept of delayed cerebral ischaemia monitoring is shifting from modalities that measure vessel diameter to techniques focusing on brain perfusion. Lastly, evolving modalities applied to assess cerebral physiological, functional and cognitive sequelae after SAH, such as functional magnetic resonance imaging or positron emission tomography, are discussed. These new techniques may have the advantage over structural modalities due to their ability to assess brain physiology and function in real time. However, their use remains mainly experimental and the literature supporting their practice is still scarce.
PMID: 25673429
ISSN: 1466-609x
CID: 2116802

Safety of early pharmacological thromboprophylaxis after subarachnoid hemorrhage

Manoel, Airton Leonardo de Oliveira; Turkel-Parrella, David; Germans, Menno; Kouzmina, Ekaterina; Almendra, Priscila da Silva; Marotta, Thomas; Spears, Julian; Abrahamson, Simon
OBJECTIVE: The recent guidelines on management of aneurysmal subarachnoid hemorrhage (aSAH) advise pharmacological thromboprophylaxis (PTP) after aneurysm obliteration. However, no study has addressed the safety of PTP in the aSAH population. Therefore, the aim of this study was to assess the safety of early PTP after aSAH. METHODS: Retrospective cohort of aSAH patients admitted between January 2012 and June 2013 in a single high-volume aSAH center. Traumatic SAH and perimesencephalic hemorrhage patients were excluded. Patients were grouped according to PTP timing: early PTP group (PTP within 24 hours of aneurysm treatment), and delayed PTP group (PTP started > 24 hours). RESULTS: A total of 174 SAH patients (mean age 56.3+/-12.5 years) were admitted during the study period. Thirty-nine patients (22%) did not receive PTP, whereas 135 patients (78%) received PTP after aneurysm treatment or negative angiography. Among the patients who received PTP, 65 (48%) had an external ventricular drain. Twenty-eight patients (21%) received early PTP, and 107 (79%) received delayed PTP. No patient in the early treatment group and three patients in the delayed PTP group developed an intracerebral hemorrhagic complication. Two required neurosurgical intervention and one died. These three patients were on concomitant PTP and dual antiplatelet therapy. CONCLUSIONS: The initiation of PTP within 24 hours may be safe after the treatment of a ruptured aneurysm or in angiogram-negative SAH patients with diffuse aneurysmal hemorrhage pattern. We suggest caution with concomitant use of PTP and dual antiplatelet agents, because it possibly increases the risk for intracerebral hemorrhage.
PMID: 25373803
ISSN: 0317-1671
CID: 2116812

The Hydration Influence on the Risk of Ischemic Stroke Outcome (THIRST-O) Study [Meeting Abstract]

Moussavi, Mohammad; Rodriguez, Gustavo; Turkel-Parrella, David; Siddique, Usama; Carlowicz, Cecilia; Botros, David; Ibrahim, Mohammad; Gizzi, Martin; Kirmani, Jawad
ISSN: 0028-3878
CID: 2122342

Safety of Intra-Arterial Bolus and Intravenous Infusion of Eptifibatide as an Adjunct to Intravenous Alteplase in Acute Ischemic Stroke: A Prospective Registry [Meeting Abstract]

Moussavi, Mohammad; Turkel-Parrella, David; Siddique, Usama; Panezai, Spozhmy; Ibrahim, Mohammad; Kirmani, Jawad
ISSN: 0028-3878
CID: 2122332

Early Results of Stenting for Acute Stroke Intervention Following Full Dose IV Alteplase (SASI-1 Study) [Meeting Abstract]

Kirmani, Jawad; Moussavi, Mohammad; Turkel-Parrella, David; Siddique, Usama; Panezai, Spozhmy; Ibrahim, Mohammad; Gizzi, Martin
ISSN: 0028-3878
CID: 2122322

Recannalization Rates and Safety of Aggressive Intra-Arterial Mechanical and Pharmalogical Endovascular Therapy (IAMPET) in Acute Ischemic Stroke [Meeting Abstract]

Kirmani, Jawad; Moussavi, Mohammad; Turkel-Parrella, David; Korya, Daniel; Panazi, Spozhmy; Ibrahim, Mohammad; Gizzi, Martin
ISSN: 0028-3878
CID: 2122312

Mild Controlled Hypothermia Induction Is Safe and Feasible for the Treatment of Intracranial Hypertension in Patients with Aneurysmal Subarachnoid Hemorrhage [Meeting Abstract]

Ibrahim, Mohammad; Turkel-Parrella, David; Hanna, Adel; Korya, Daniel; Wirkowski, Elzbieta; Kirmani, Jawad
ISSN: 0028-3878
CID: 2122352