Abstract W P292: Variable Frequencies, Outcomes and Costs Argue for Separate Tracking of Ischemic Strokes (ISs), Subarachnoid Hemorrhages (SAHs) and Other Hemorrhagic Strokes (OHSs)
Introduction: While cause and treatment vary for ISs, SAHs and OHSs, their results are often combined in reported statistics.
Hypothesis: ISs, SAHs and OHSs differ in frequency and outcomes.
Methods: ICD-9-CM principal discharge (D/C) diagnosis codes of 430 (SAH), 431-432 (OHS) and 433-434 (IS) were used to obtain US nationwide estimates of stroke frequency and outcomes for 2006-2012 from HCUPnet, the on-line query system of the Healthcare Cost and Utilization Project (HCUP). HCUP's sampling frame captured ~90% of D/Cs from non-Federal acute care hospitals for 2006, and >95% of such D/Cs as of 2012. Data came from HCUP's Nationwide Inpatient
Sample, which captures 100% of D/Cs from a stratified sample of 20% of HCUP hospitals.
Results: There were 2,005 cases (2.7/100,000) seen in 0-17 year-olds (YOs) in both 2006 and 2012. While 33.9 vs 34.2% were ISs, 19.5 vs 17.0% were SAHs, and 46.6 vs 48.9% were OHSs. Analyses focused on 18+ YOs estimated that there were 653,429 such cases (290.1/100,000) in 2006. Among ISs (82.0% of cases), 4.4% died as inpatients, 49.3% were routine D/Cs and the rest (46.3%) were D/Cd to other care settings. Mean length of stay (MLOS) was 4.8 days. Mean hospital costs (not charges) were $10,059/case (in 2012 US $). Among SAHs (4.1%), inpatient mortality was 23.1% and 35.2% were routine D/Cs. MLOS was 12.3 days. Mean costs were $41,941. Among OHSs (13.9%), 24.3% died as inpatients and 24.3% were routine D/Cs. MLOS was 7.8 days. Mean costs were $17,456. Some 680,980 adult cases (283.5/100,000) were seen in 2012. Among ISs (82.5%), 3.7% died as inpatients; 45.7% were routine D/Cs. MLOS was 4.5 days. Mean costs were $11,651. Among SAHs (3.6 %), mortality was 19.6%; 37.2% were routine D/Cs. MLOS was 11.7 days. Mean costs were $50,372. Among OHSs (13.9 %), mortality was 21.7%; 23.3% were routine D/Cs. MLOS was 7.4 days. Mean costs were $19,871.
Discussion: While pediatric and adult stroke D/C rates were stable from 2006-12, they were much more common in adults. Subtype distributions differed. Adult inpatient mortality fell while LOS varied. Overall adult inflation-adjusted acute care hospital costs rose from $8 to 10 trillion/year. Lower rates, worse outcomes and higher resource use seen in SAHs and OHSs relative to ISs argue for separate tracking of subtype results.
Author Disclosures: D.T. Gray: None.
- © 2015 by American Heart Association, Inc.