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ARTICLES: Haifeng Zhu and Michael D. Hill Stroke: The Elixhauser Index for comorbidity adjustment of in-hospital case fatality Neurology 2008; 71: 283-287 [Abstract] [Full text] [PDF]

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Stroke: The Elixhauser Index for comorbidity adjustment of in-hospital case fatality

William D. Freeman   (22 September 2008)

Reply from the authors

Michael D. Hill, Hai Feng Zhu   (22 September 2008)

Stroke: The Elixhauser Index for comorbidity adjustment of in-hospital case fatality 22 September 2008
William D. Freeman, Mayo Clinic 4500 San Pablo Road South, Cannaday 2E, Jacksonville, FL 32224 Send Correspondence to journal: Re: Stroke: The Elixhauser Index for comorbidity adjustment of in-hospital case fatality freeman.william1{at}mayo.edu William D. Freeman	I read with great interest the article by Zhu et al. [1] However, I did not see that any screening for dysphagia or aspiration pneumonia was made. If this search was made, it is possible that the population was excluded. If this screening was not done and this was added using ICD (9 or 10) search terms for dysphagia (787.20) or aspiration pneumonia (507.0) what impact this would have on inpatient fatality? Most stroke patients who aspirate and get pneumonia have a prolonged length of stay and increased morbidity and mortality compared to those who have stroke but do not have pneumonia. The Stroke Centers by Joint Commission in the US are required to document dysphagia screening to gauge aspiration risk. Reference 1. Zhu, H, Hill MD. Stroke: The Elixhauser Index for comorbidity adjustment of in-hospital case fatality Neurology 2008;71:283-287. Disclosure: The author reports no disclosures.
Reply from the authors 22 September 2008
Michael D. Hill, University of Calgary Foothills Hospital, Rm 1242A, 1403 29th Street NW, Calgary, AB, T2N 2T9, CANADA, Hai Feng Zhu Send Correspondence to journal: Re: Reply from the authors michael.hill{at}calgaryhealthregion.ca Michael D. Hill, et al.	We thank Dr. Freeman for his comments. We did not use codes for dysphagia or pneumonia to identify potential stroke patients. We believe that these codes would be relatively non-specific but agree that using such codes would allow the identification of more strokes. Dr. Freeman’s point illustrates why passive surveillance of stroke using administrative data is limited by the extent of the data definition. We did not investigate whether, among stroke patients with dysphagia or with pneumonia as a co-morbid code, there was a higher mortality or longer length of stay compared to those without such codes. We suspect that Dr. Freeman is correct. In Canada, there is ongoing work spearheaded by the Canadian Stroke Network and the Heart & Stroke Foundation of Canada to include elements of stroke care (e.g., dysphagia screening) in hospital accreditation. Similar to the Joint Commission in the United States, we soon hope to have similar accreditation standards for stroke hospitals and indicators such as dysphagia and aspiration screening will be routinely reported. Disclosure: The authors report no disclosures.