Using Administrative Data to Study Outcomes After Surgical Treatment of Chairi Malformation Type 1

ICTS Just-In-Time Award

Awarded a 2013 ICTS Core Usage Just-In-Time (JIT) Grant on “Using Administrative Data to Study Outcomes After Surgical Treatment of Chiari Malformation Type 1”, David Limbrick Jr MD PhD, an Associate Professor with joint appointments in Neurological Surgery and Pediatrics, worked with data from the Center for Administrative Data Research (CADR)  repository to study this rare neurological defect. Chiari malformations are structural defects in the cerebellum, the portion of the brain that controls balance and can range from acquired, asymptomatic settings where diagnosis is made by accident to more serious conditions with significant neurological defects.  Syringomyelia (SM) is a debilitating condition characterized by abnormal fluid accumulation within the spinal cord and is associated with Chiari Type I malformation at the brain-spinal cord junction.

In recent updates,

  • Dr. Limbrick received a $2.8 Million grant from the Patient Center Outcomes Research Institute (PCORI) to study “Posterior Fossa Decompression with or without Duraplasty for Chiari Type I Malformation with Syringomyelia” and determine the comparative effectiveness of options for this rare surgical procedure.  This cluster randomized controlled trial (RCT) aims to determine which of the approaches maximizes resolution of symptoms (including chronic pain, neurological deficits, and spinal deformity) and provides an improvement in quality of life (QOL) while minimizing the risk of harm.  The results will facilitate the development of evidence-based treatment guidelines and provide patients and stakeholders valuable information necessary to inform health decisions.

  • Four publications with CADR have maximized the value of State Inpatient Databases to provide foundational research support underpining the PCORI grant. One study took a population perspective on complications and resource utilization [PMCID: PMC4506249], and a second publication validated an international classification system [PMCID: PMC4506217] for surgery.  Two recent publications in J Neurosurg Pediatr from January 2016 examine the disorder in pediatric populations, by validating an ICD-9 code search algorithm for the surgery in children [PMCID: PMC4853277] and by examining surgical complications and the influence of comorbid disease in California, Florida, and New York [PMCID: PMC4876706].