J Korean Med Sci.  2020 Jun;35(21):e135. 10.3346/jkms.2020.35.e135.

Impact of the Dedicated Neurointensivists on the Outcome in Patients with Ischemic Stroke Based on the Linked Big Data for Stroke in Korea

• Kim TJ
• Lee JS
• Yoon JS
• Oh MS
• Kim JW
• Jung KH
• Yu KH
• Lee BC
• Ko SB
• Yoon BW
• on behalf of Clinical Research Collaboration for Stroke (CRCS) investigators

• KMID: 2502239
• DOI: http://doi.org/10.3346/jkms.2020.35.e135

Abstract

Background
Neurocritical care by dedicated neurointensivists may improve outcomes of critically ill patients with severe brain injury. In this study, we aimed to validate whether neurointensive care could improve the outcome in patients with critically ill acute ischemic stroke using the linked big dataset on stroke in Korea.
Methods
We included 1,405 acute ischemic stroke patients with mechanical ventilator support in the intensive care unit after an index stroke. Patients were retrieved from linking the Clinical Research Center for Stroke Registry and the Health Insurance Review and Assessment Service data from the period between January 2007 and December 2014. The outcomes were mortality at discharge and at 3 months after an index stroke. The main outcomes were compared between the centers with and without dedicated neurointensivists.
Results
Among the included patients, 303 (21.6%) were admitted to the centers with dedicated neurointensivists. The patients treated by dedicated neurointensivists had significantly lower in-hospital mortality (18.3% vs. 26.8%, P = 0.002) as well as lower mortality at 3-month (38.0% vs. 49.1%, P < 0.001) than those who were treated without neurointensivists. After adjusting for confounders, a treatment without neurointensivists was independently associated with higher in-hospital mortality (odds ratio [OR], 1.59; 95% confidence intervals [CIs], 1.13–2.25; P = 0.008) and 3-month mortality (OR, 1.48; 95% CIs, 1.12–1.95; P = 0.005).
Conclusion
Treatment by dedicated neurointensivists is associated with lower in-hospital and 3-month mortality using the linked big datasets for stroke in Korea. This finding stresses the importance of neurointensivists in treating patients with severe ischemic stroke.

Keyword

Ischemic Stroke; Neurointensivist; Neurocritically Ill Patients; Outcome; Big Data

Figure

• 

  Fig. 1 Association between neurointensivists care and outcomes according to subgroups in critically ill patients with acute ischemic stroke. (A) Adjusted for in-hospital mortality. (B) Adjusted for 3-months mortality.ORs with corresponding 95% CIs for dedicated neurointensivists care within subgroups. Adjusting for without neurointensivist, age, gender, previous stroke/transient ischemic attacks, hyperlipidemia, diabetes mellitus, hypertension, smoking, atrial fibrillation, coronary artery disease, initial NIHSS, previous modified Rankin scale, thrombolytic therapy, and stroke subtypesOR = odds ratio, CI = confidence interval, NIHSS = National Institutes of Health Stroke Scale.

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