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Abstract Details

Risk Stratification by Hemorrhage Location for Intracerebral Hemorrhage Patients in Large Administrative Databases
Cerebrovascular Disease and Interventional Neurology
P12 - Poster Session 12 (12:00 PM-1:00 PM)
4-015
To examine the utilization of hemorrhage location specific ICD 10 codes for Intracerebral Hemorrhage (ICH) patients across various demographic, hospital, and disease severity factors for fourth quarter (Q4) 2015-2016 of the Nationwide Inpatient Sample (NIS). 
NIS represents 90% of US hospitalizations. Beginning Q4 2015, NIS transitioned to ICD 10. ICD 10 codes for ICH are hemorrhage location specific, which predicts outcomes. We report in-hospital mortality (IHM) for various hemorrhage locations and assess factors associated with use of non-specific codes (NSC).

We used ICD 10 codes (i610-16, i618-19) to identify non-traumatic ICH discharges. We categorized hemorrhage locations as (1) Hemispheric (cortical or subcortical) [i610–12], (2) Brain Stem or Cerebellar [i613-14], (3) Intraventricular Hemorrhage (IVH) [i615], (4) Multiple Localized [i616], and (5) Other and Not Specified [i618-19]. We considered ‘Other and Not Specified’ category as NSC and fit survey design logistic regression models for factors associated with NSC. 
We identified 79,290 ICH discharges of which 38.9% were NSC and 29.7% were hemispheric. IHM ranged from 15.1% for hemispheric ICH to 34.7% for IVH. In the fully adjusted model NSC coded ICH discharges (IHM: 20.2%) were independently associated with advanced age and white race (vs. African American). ICH discharges from urban teaching hospitals were less likely to be NSC as compared to rural hospitals (OR, 95% CI: 0.7, 0.6 – 0.8). Patients discharged from large and medium size hospitals were 28% and 17% more likely to be provided a specific code as compared to smaller hospitals. Northeast US Hospitals were more likely to use NSC. 
Though ICD 10 codes provide an opportunity for risk adjustment in administrative data for ICH, up to 40% of discharges had NSC which is more prevalent in smaller/rural/Northeast hospitals. Our work sets a foundation for examining bias caused by NSC in future studies.
Authors/Disclosures

PRESENTER 		No disclosure on file
Jennifer Meeks No disclosure on file
No disclosure on file
No disclosure on file
Sunil Sheth, MD (University of Texas At Houston) Dr. Sheth has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Penumbra. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imperative Care.
Sean I. Savitz, MD Dr. Savitz has nothing to disclose.
Wendy C. Ziai, MD (Johns Hopkins Univ, Neuro Critical Care) Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Ziai has received research support from NIH. Dr. Ziai has received publishing royalties from a publication relating to health care. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as a Consultant with DOJ.
Daniel F. Hanley, MD, FÂ鶹´«Ã½Ó³»­ (Johns Hopkins Medicine, Acute Care Neurology) Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Neurotrope. Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various law firms. The institution of Dr. Hanley has received research support from NIH/NCATS. The institution of Dr. Hanley has received research support from NIH/NINDS.
Farhaan S. Vahidy, MBBS, PhD (Houston Methodist) Dr. Vahidy has nothing to disclose.