Capturing Intravenous Thrombolysis for Acute Stroke at the ICD‐9 to ICD‐10 Transition: Case Volume Discontinuity in the United States National Inpatient Sample

Background Transition fromInternational Classification of Diseases (ICD )Ninth andTenth Revisions (ICD‐9 andICD‐10 ) for hospital discharge data was mandated for US hospitals on October 1, 2015. We examined the volume of patients receiving thrombolysis in ischemic stroke (IS) identified usingICD codes within this transition period in the 2015 to 2016 National Inpatient Sample, a weighted 20% sample of all inpatient US hospital discharges.Methods and Results During theICD‐10 period, 2 case identification strategies were used. Codes for IS were combined with: (1) only theICD‐10 code for thrombolytic given into a peripheral vein and (2) all newICD‐10 codes mapped to theICD‐9 code for all thrombolysis. On visual inspection there was an obvious discontinuity in the volume of patients with IS treated with IV thrombolysis corresponding to 3 time periods:ICD‐9 (study period 1), transition (period 2), andICD‐10 (period 3). With Strategy 1, analysis using a linear spline with 2 knots shows that the volume of patients with IS treated with IV thrombolysis was significantly different between study periods 1 and 2 (slope difference −1880, 95% CI −2834 to −928,P =0.005), and periods 2 to 3 (slope difference 1980, 95% CI 1207–2754,P  = 0.002). With Strategy 2, volumes did not change significantly between periods 1 to 2, though there was a significant difference between periods 2 and 3 (slope difference 719, 95% CI 91–1347,P =0.034).Conclusions The significant discontinuity in thrombolysis volumes for IS during the transition period forICD‐9 toICD‐10 coding suggests that more rigorous validation of US administrative data during this time period may be necessary for research, resource planning, and quality assurance.