Development of stroke identification algorithm for claims data using the multicenter stroke registry database

• Published in: PloS one Vol. 15; no. 2; p. e0228997
• Main Authors: Kim, Jun Yup, Lee, Keon-Joo, Kang, Jihoon, Kim, Beom Joon, Han, Moon-Ku, Kim, Seong-Eun, Lee, Heeyoung, Park, Jong-Moo, Kang, Kyusik, Lee, Soo Joo, Kim, Jae Guk, Cha, Jae-Kwan, Kim, Dae-Hyun, Park, Tai Hwan, Park, Moo-Seok, Park, Sang-Soon, Lee, Kyung Bok, Park, Hong-Kyun, Cho, Yong-Jin, Hong, Keun-Sik, Choi, Kang-Ho, Kim, Joon-Tae, Kim, Dong-Eog, Ryu, Wi-Sun, Choi, Jay Chol, Oh, Mi-Sun, Yu, Kyung-Ho, Lee, Byung-Chul, Park, Kwang-Yeol, Lee, Ji Sung, Jang, Sujung, Chae, Jae Eun, Lee, Juneyoung, Bae, Hee-Joon
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.02.2020; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Algorithms; Anticoagulants; Biology and Life Sciences; Cardiac arrhythmia; Cardiovascular system; Classification; Clinical trials; Databases, Factual; Datasets; Diagnostic imaging; Diagnostic systems; Diseases; Female; Hemorrhage; Hospitals; Humans; Insurance; Insurance Claim Review; Ischemia; Magnetic Resonance Imaging; Male; Medical records; Medical research; Medical schools; Medicine and Health Sciences; Middle Aged; National health insurance; Neuroimaging; Neurology; Preventive medicine; Registries; Republic of Korea; Research and Analysis Methods; Stroke; Stroke - diagnostic imaging; Stroke - therapy; t-Plasminogen activator; Thrombolytic drugs; Tissue plasminogen activator; Tomography, X-Ray Computed; Republic of Korea; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0228997

Identifying acute ischemic stroke (AIS) among potential stroke cases is crucial for stroke research based on claims data. However, the accuracy of using the diagnostic codes of the International Classification of Diseases 10th revision was less than expected. From the National Health Insurance Service (NHIS) claims data, stroke cases admitted to the hospitals participating in the multicenter stroke registry (Clinical Research Collaboration for Stroke in Korea, CRCS-K) during the study period with principal or additional diagnosis codes of I60-I64 on the 10th revision of International Classification of Diseases were extracted. The datasets were randomly divided into development and validation sets with a ratio of 7:3. A stroke identification algorithm using the claims data was developed and validated through the linkage between the extracted datasets and the registry database. Altogether, 40,443 potential cases were extracted from the NHIS claims data, of which 31.7% were certified as AIS through linkage with the CRCS-K database. We selected 17 key identifiers from the claims data and developed 37 conditions through combinations of those key identifiers. The key identifiers comprised brain CT, MRI, use of tissue plasminogen activator, endovascular treatment, carotid endarterectomy or stenting, antithrombotics, anticoagulants, etc. The sensitivity, specificity, and diagnostic accuracy of the algorithm were 81.2%, 82.9%, and 82.4% in the development set, and 80.2%, 82.0%, and 81.4% in the validation set, respectively. Our stroke identification algorithm may be useful to grasp stroke burden in Korea. However, further efforts to refine the algorithm are necessary.