Abstract P297: The Accuracy of the Comprehensive Stroke Performance CSTK-5b Measure Rates

Introduction: Symptomatic intracerebral hemorrhage (ICH) is a feared complication of reperfusion therapy in acute ischemic stroke. The Joint Commission (JC) national quality measure Comprehensive Stroke (CSTK-5b) reflects the rate of symptomatic ICH after mechanical thrombectomy (MT) and is used as a marker of comprehensive stroke center (CSC) performance. We sought to determine the accuracy of the CSKT-5b as determined by vascular neurologists.

Methods: We reviewed the CSTK-5b failures in our JC certified CSC program for the years 2018 and 2019. Our CSC abstractors follow the instructions from the Joint Commission National Quality Measures manual without deviation and do not allow for clinician over-ride or adjudication (consistent with manual instructions). All CSKT-5b failures were reviewed by study neurologists to determine the true CSTK-5b rate. Data was collected on National Institute of Health Stroke Scale (NIHSS), symptomatic ICH, and neuroimaging results. European Cooperative Acute Stroke Study (ECASS) definitions were used and included hemorrhagic infarction (HI) (grade 1 or 2) and parenchymal hematoma (PH) (grade 1 or 2).

Results: Among 361 MT patients for the 2 year period, the CSTK-5b failure rate reported to JC was 34/250 (13.6%), whereas the true rate was 21/250 (8.4%). Among the 13 cases that were miscoded, the ECASS grading included 1 HI-1, 7 HI-2, 1 PH-1, and 4 subarachnoid hemorrhage, and all had a 4 point change in NIHSS that was determined to be clinically unrelated to ICH. Comparing annual data, the 2018 CSTK-5b failure rate was 14/111 (12.6%) whereas the true CSTK-5b failure rate was 7/111 (6.3%). In 2019, the CSTK 5b failure rate was 20/139 (14.4%), whereas the true CSTK-5b failure rate was 14/139 (10.1%).

Conclusions: Non-physician abstractors relying on instructions from the JC manual over-estimate the rate of CSKT-5b measure failure. The determination of symptomatic ICH after MT is complex and requires clinical knowledge for accuracy.

Global Cerebral Atrophy Detected by Routine Imaging: Relationship with Age, Hippocampal Atrophy, and White Matter Hyperintensities

BACKGROUND AND PURPOSE

Interpreting the clinical significance of moderate-to-severe global cerebral atrophy (GCA) is a conundrum for many clinicians, who visually interpret brain imaging studies in routine clinical practice. GCA may be attributed to normal aging, Alzheimer's disease (AD), or cerebrovascular disease (CVD). Understanding the relationships of GCA with aging, AD, and CVD is important for accurate diagnosis and treatment decisions for cognitive complaints.

METHODS

To elucidate the relative associations of age, moderate-to-severe white matter hyperintensities (WMHs), and moderate-to-severe medial temporal lobe atrophy (MTA), with moderate-to-severe GCA, we visually rated clinical brain imaging studies of 325 participants from a community based sample. Logistic regression analysis was conducted to assess the relations of GCA with age, WMH, and MTA.

RESULTS

The mean age was 76.2 (±9.6) years, 40.6% were male, and the mean educational attainment was 15.1 (±3.7) years. Logistic regression results demonstrated that while a 1-year increase in age was associated with GCA (OR = 1.04; P = .04), MTA (OR = 3.7; P < .001), and WMH (OR = 8.80; P < .001) were strongly associated with GCA in our study population. Partial correlation analysis showed that the variance of GCA explained by age is less than the variance attributed to MTA and WMH (r = .13, .21, and .43, respectively).

CONCLUSIONS

Moderate-to-severe GCA is most likely to occur in the presence of AD or CVD and should not be solely attributed to age when evaluating clinical imaging findings in the workup of cognitive complaints. Developing optimal diagnostic and treatment strategies for cognitive decline in the setting of GCA requires an understanding of its risk factors in the aging population.