Cadilhac and colleagues1 explore an important issue in the measurement and reporting of stroke outcomes. We agree that appropriate risk-adjustment methods are essential to compare hospital outcomes. We also agree that stroke severity is an important predictor of mortality for individual patients. However, we do not agree that determining stroke severity is essential for robust risk-adjustment approaches.
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- 1. Cadilhac DA, Kilkenny MF, Levi CR, et al. Risk-adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR). Med J Aust 2017; 206: 345-350. <MJA full text>
- 2. Bureau of Health Information. The Insights Series: Exploring clinical variation in mortality — mortality following hospitalisation, seven clinical conditions, NSW, July 2012 – June 2015. Sydney: BHI, 2017.
- 3. Spiegelhalter D. Funnel plots for comparing institutional performance. Stat Med 2005; 24: 1185-1202.
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