Creation of a Computable Phenotype in Childhood- Onset Arterial Ischemic Stroke (CAIS)
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Abstract
The primary aim of this study is to incorporate discrete data elements included in the PEDSnet database to create a valid computable phenotype for childhood arterial ischemic stroke (CAIS), using a rule-based approach. The phenotype should identify all types of childhood arterial ischemic stroke, an entity which is defined by multiple stroke subtypes and at-risk patient populations, especially in patients with sickle cell disease (SCD) as patients with SCD present to care frequently for pain and other disease complications, and presentation and evaluation of stroke in SCD may differ from all-cause stroke.
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Description
The primary objective of this analysis is to develop a valid, automated method to identify children with CAIS using an EHR database, and to specifically ensure this method is valid in patients with SCD, who may present differently from others. We will use our validated CP to examine the epidemiology of stroke in SCD in a modern cohort, identify temporal trends in stroke rates, and examine risk factors for stroke in SCD. As TCD screening is the mainstay of stroke prevention in SCD, we will also use PEDSnet to perform a comparative assessment of TCD reporting strategies across sites and include TCD results as a variable in our descriptive analysis of stroke in SCD.
Study Aims
Aim 1: To derive and internally validate a computable phenotype to identify childhood arterial ischemic stroke in children and adolescents.
- Hypothesis: This CP will have a minimum 85% positive predictive value (PPV) in single-center validation.
Aim 2: To externally validate the CP in SCD-CAIS and all-cause CAIS.
- Hypothesis: A single CP will have a minimum 85% PPV in both all-cause CAIS and SCD-CAIS.
Aim 3. To perform a comparative assessment of TCD reporting strategies across all PEDSnet sites.
- Hypothesis: Despite variation in TCD reporting strategies, we will be able to use automated methods to accurately ascertain TCD results among multiple sites.
Study Design
This is a retrospective cohort study to evaluate EHR markers of childhood arterial ischemic stroke in children and young adults with and without sickle cell disease, and to evaluate stroke risk factors for those with SCD treated in the current era.
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