ABSTRACT
BACKGROUND: Linkage of public healthcare data is useful in stroke research because patients may visit different sectors of the health system before, during, and after stroke. Therefore, we aimed to establish high-quality big data on stroke in Korea by linking acute stroke registry and national health claim databases. METHODS: Acute stroke patients (n = 65,311) with claim data suitable for linkage were included in the Clinical Research Center for Stroke (CRCS) registry during 2006–2014. We linked the CRCS registry with national health claim databases in the Health Insurance Review and Assessment Service (HIRA). Linkage was performed using 6 common variables: birth date, gender, provider identification, receiving year and number, and statement serial number in the benefit claim statement. For matched records, linkage accuracy was evaluated using differences between hospital visiting date in the CRCS registry and the commencement date for health insurance care in HIRA. RESULTS: Of 65,311 CRCS cases, 64,634 were matched to HIRA cases (match rate, 99.0%). The proportion of true matches was 94.4% (n = 61,017) in the matched data. Among true matches (mean age 66.4 years; men 58.4%), the median National Institutes of Health Stroke Scale score was 3 (interquartile range 1–7). When comparing baseline characteristics between true matches and false matches, no substantial difference was observed for any variable. CONCLUSION: We could establish big data on stroke by linking CRCS registry and HIRA records, using claims data without personal identifiers. We plan to conduct national stroke research and improve stroke care using the linked big database.
Subject(s)
Humans , Male , Delivery of Health Care , Information Storage and Retrieval , Insurance, Health , Korea , National Health Programs , Parturition , StrokeABSTRACT
PURPOSE: This study was designed to analyze the malignancy rate for thyroid nodules determined after a fine needle aspiration biopsy (FNAB) and ultrasonography (US) and to propose follow-up FNAB indications. MATERIALS AND METHODS: A total of 287 patients (265 female, 22 male) who underwent repeated US-guided FNABs were included in the cohort study. The results of the FNABs were classified as inadequate, benign, indeterminate, suspicious for a malignancy and a malignancy. The US findings were assigned five grades according to the possibility of a malignancy present. The frequency of a malignant nodule was evaluated by the use of the Kaplan-Meier method and Cox proportional risk model. RESULTS: The malignancy rates of inadequate, benign, and indeterminate nodules were 12.8%, 8.2% and 37.5%, respectively, for the FNAB findings. The rates of grades 3, 4 and 5 were 38.6%, 50.0% and 53.8%, respectively, for the US findings. Inadequate and indeterminate nodules as determined by an FNAB and grades 3, 4 and 5 assigned after US showed a higher malignancy rate than other nodules and would be regarded as high risk lesions. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 93.3%, 38.4%, 22.0%, 96.9% and 47.0%, respectively, if the nodule was considered a high-risk lesion, based on the FNAB or US findings. CONCLUSION: Thyroid nodules should be evaluated based on an FNAB and US findings. If a thyroid nodule is classified as a high-risk lesion, a follow-up study is needed due to the high malignancy rate.
Subject(s)
Female , Humans , Biopsy , Biopsy, Fine-Needle , Cohort Studies , Follow-Up Studies , Sensitivity and Specificity , Thyroid Gland , Thyroid NoduleABSTRACT
PURPOSE: This study was performed to evaluate factors that can predict the presence of a malignancy for localized intrahepatic bile duct dilatation without a visible mass or stone as depicted on CT images. MATERIALS AND METHODS: A total of 29 patients (male: 16, female: 13) who had localized intrahepatic bile duct dilatation without a visible mass, stone or injury as depicted on CT images were included in the study. A history of extrahepatic malignancy and biliary stone disease, tumor marker levels, CT findings of the intrahepatic bile duct and associated findings were reviewed. The findings were analyzed between two groups (patients with a malignancy and patients with benign disease) on follow-up. RESULTS: In 29 patients, 11 patients had malignant lesions (four metastases and seven cholangiocarcinomas). The history of an extrahepatic malignancy and the shape of an intrahepatic duct obstruction or stenosis as seen on CT were significantly correlated with the results between the benign and malignant group of patients. The follow-up results of the malignant group of patients indicated that for six patients who had developed a new mass, one patient each showed aggravation of ductal dilatation and thickening of the ductal wall. CONCLUSION: When a patient with localized intrahepatic bile duct dilatation without a definite cause has a history of an extrahepatic malignancy or shows abrupt tapering or irregular narrowing on CT images, short-term follow-up should be performed. The patient should be investigated carefully for mass formation or a change of the dilated bile duct due to a possibility of malignant ductal dilatation.
Subject(s)
Humans , Bile Ducts , Bile Ducts, Intrahepatic , Constriction, Pathologic , Dilatation , Dilatation, Pathologic , Follow-Up Studies , Neoplasm MetastasisABSTRACT
PURPOSE: To evaluate the usefulness of resistive index using carotid Doppler sonography for understanding hemodynamics in acute stroke patients. MATERIALS and METHODS: We retrospectively reviewed Doppler sonography in 97 acute stroke patients and 235 asymptomatic patients. We compared the resistive index between the ipsilateral and contralateral internal carotid arteries, and analyzed the relationship between the degree of stenosis and the resistive index of the internal carotid artery using linear regression analysis. We divided our patients into two groups according to the ASPECT score (7 and more and less than 7) determined from diffusion and T2 weighted images. Then we analyzed the difference of Doppler sonographic parameters between these two groups (independent t test). RESULTS: The resistive indices of both the ipsilateral internal carotid arteries of the acute stroke patients and the arteries of the asymptomatic patients showed a positive correlation with their respective degrees of stenosis (R2 = 0.127, p < 0.001; R2 = 0.046, p < 0.001, respectively). However, the resistive index of the contralateral internal carotid arteries was not correlated with their degree of stenosis (R2 = 0.016, p = 0.215). The resistive index of the ipsilateral internal carotid arteries in the acute stroke patients was significantly higher in the patients with ASPECT more than 7 than those with ASPECT score less than 7 (p = 0.002). CONCLUSION: Evaluation of the resistive index of the internal carotid arteries in acute stroke patients may be useful for understanding the cerebral hemodynamics.
Subject(s)
Humans , Arteries , Carotid Artery, Internal , Constriction, Pathologic , Diffusion , Hemodynamics , Linear Models , Retrospective Studies , Stroke , Ultrasonography , Ultrasonography, DopplerABSTRACT
No abstract available.
ABSTRACT
No abstract available.