The new International Statistical Classification of Diseases and Related Health Problems (ICD-11) of the World Health Organization (WHO)'s has returned cerebrovascular diseases from the circulatory diseases chapter to diseases of the nervous system.
Raad Shakir, MD, Imperial College London, United Kingdom, and president of the World Federation of Neurology (WFN) proposed change of classification for cerebrovascular disease in an editional published in The Lancet in October 2016 and since then the WHO reclassify stroke as a cerebrovascular disease not a circulatory disorder.
Dr Shakir, said that "There are very good reasons why the WHO neurology advocated that all types of stroke should form a single block in the new classification and be part of the nervous system disease chapter. All manifestations of cerebrovascular disease are related to brain dysfunction."
The statement notes that the ICD-10 currently in place is based on outdated medical knowledge and concepts. The new ICD-11, which has been under discussion since 2009, is aimed at reflecting the changes in science and practice and is slated for release in 2018.
In 1955,
cerebrovascular diseases were reclassified as circulatory system diseases in
the 7th edition of the ICD. WHO's idea then was that stroke is a condition
affecting blood vessels. This decision to reclassify cerebrovascular diseases
seemed contrary to the pathophysiology and symptoms leading to mortality and
morbidity, which are those of brain dysfunction.
Stroke
became a Cinderella disease, attracting little attention since it was thought
that treatment was not available. Treatment of stroke has been revolutionised
over the past 20 years, since the advent of stroke units, thrombolysis, and
thrombectomy. Hyper acute stroke units save lives if ischaemic stroke is
treated within the first 4·5 h. The incorrect classification of stroke led to
delay in resource allocation and training of medical, radiological, and nursing
staff who know how to deal with brain diseases. The link to low allocation of
resources for stroke care is clear to see.
ICD -10
cerebrovascular diseases classification
|
ICD -11 cerebrovascular diseases
classification
|
Stroke-
In disease of the Circulatory System
|
Single
block of cerebrovascular disease within Diseases of the Nervous System,
Includes
definitions of all diagnostic codes.
Block
includes TIA, Stroke and cerebrovascular diseases not causing acute neurological dysfynction (silent
cerebrovascular infarcts, cerebral microbleed)
|
Transient
Ischemic attacks- In disease of the Nervous
System
|
|
Silent
cerebrovascular disease- Under incidental imaging findings
|
All those new changes in the ICD -11
classification mean that if stroke occur, it occurs in the brain. Also, it
provides more clarity and clinical usefulness. Stroke is no longer in the
shadow of other cerebrovascular diseases.
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