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- ArticleBaldereschi M, Balzi D, Di Fabrizio V, De Vito L, Ricci R, D'Onofrio P, Di Carlo A, Mechi MT, Bellomo F, Inzitari D.PLoS One. 2018;13(3):e0193776.BACKGROUND: Informing health systems and monitoring hospital performances using administrative data sets, mainly hospital discharge data coded according to International-Classification-Diseases-9edition-Clinical-Modifiers (ICD9-CM), is now commonplace in several countries, but the reliability of diagnostic coding of acute ischemic stroke in the routine practice is uncertain. This study aimed at estimating accuracy of ICD9-CM codes for the identification of acute ischemic stroke and the use of thrombolysis treatment comparing hospital discharge data with medical record review in all the six hospitals of the Florence Area, Italy, through 2015.
METHODS: We reviewed the medical records of all the 3915 potential acute stroke events during 2015 across the six hospitals of the Florence Area, Italy. We then estimated sensitivity and Positive Predictive Value of ICD9-CM code-groups 433*1, 434*1 and thrombolysis code 99.10 against medical record review with clinical adjudication. For each false-positive case we obtained the actual diagnosis. For each false-negative case we obtained the primary and secondary ICD9-CM diagnoses.
RESULTS: The medical record review identified 1273 acute ischemic stroke events. The hospital discharge records identified 898 among those (true-positive cases),but missed 375 events (false-negative cases), and identified 104 events that were not eventually confirmed as acute ischemic events (false-positive cases). Code-group specific Positive Predictive Value was 85.7% (95%CI,74.6-93.3) for 433*1 and 89.9% (95%CI, 87.8-91.7) for 434*1 codes. Thrombolysis treatment, as identified by ICD9-CM code 99.10, was only documented in 6.0% of acute ischemic stroke events, but was 13.6% in medical record review.
CONCLUSIONS: Hospital discharge data were found to be fairly specific but insensitive in the reporting of acute ischemic stroke and thrombolysis, providing misleading indications about both quantity and quality of acute ischemic stroke hospital care. Efforts to improve coding accuracy should precede the use of hospital discharge data to measure hospital performances in acute ischemic stroke care. - BookAlaa Abd-Elsayed, MD, MPH, CPE, FASA.Summary: Radiofrequency Augmentation Techniques, part of the Atlas of Interventional Pain Management series, is a concise, practical guide that provides clinicians with detailed, step-by-step guidance on how to perform the latest interventional techniques for treating patients with chronic pain. This comprehensive, easy-to-follow guide offers expert coverage of how to deliver safe, accurate, and cost-effective pain relief to patients using all clinically useful imaging modalities, including ultrasound-guided techniques and fluoroscopy. With high-quality images and clear, authoritative guidance throughout, it shows exactly how to evaluate the causes of pain, identify the most promising stimulation technique, locate the site with precision, and deliver effective relief.
Contents:
History of radiofrequency ablation (RFA)
Mechanism of action
Patient selection, indications, and contraindications
Perioperative management
Cervical medical branches
Thoracic medical branches
Lumbar medical branches
Radiofrequency ablation involving the sacroiliac joint
Radiofrequency ablation of hip joint articular nerves
Knee joint
Ankle joint articular nerves
Shoulder joint
Radiofrequency ablation and pulsed radiofrequency of the upper extremities
Radiofrequency ablation and pulsed radiofrequency of the lower extremities
Radiofrequency ablation for headache
Radiofrequency ablation and pulsed radiofrequency ablation for the sympathetic nervous system
Radiofrequency ablation of the medical branch in the presence of other devices
Radiofrequency ablation complications and management
Measuring outcomes.Digital Access ClinicalKey [2023]