J Korean Neurosurg Soc.  2023 Jan;66(1):24-32. 10.3340/jkns.2022.0085.

Role of Neurosurgeons in the Treatment of Acute Ischemic Stroke in the Emergency Room

• Lee SH
• Nam TM
• Jang JH
• Kim YZ
• Kim KH
• Ryu KH
• Kim DH
• Kwan BS
• Lee H
• Kim SH

• KMID: 2537845
• DOI: http://doi.org/10.3340/jkns.2022.0085

Abstract

Objective
: With the recent increase in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), the role of neurosurgeons in AIS treatment has become increasingly important. This study aimed to assess the outcomes of patients with AIS treated by neurosurgeons and neurologists in the emergency room (ER) of a tertiary hospital in South Korea.
Methods
: From January 2020 to June 2021, 536 patients with AIS within 24 hours of symptom onset were admitted to our hospital via the ER. Based on the type of doctors who provided initial care for AIS in the ER, patients were divided into two groups : (a) neurosurgeon group (n=119, 22.2%) and (b) neurologist group (n=417, 77.8%).
Results
: Intravenous tissue plasminogen activator (tPA) was administered in 82 (15.3%) of 536 patients (n=17 [14.3%] in the neurosurgeon group and n=65 [15.6%] in the neurologist group). The door-to-tPA time was not significantly different between both groups (median, 53 minutes; interquartile range [IQR], 45–58 vs. median, 54 minutes; IQR, 46–74; p=0.372). MT was performed in 69 patients (12.9%) (n=25, 36.2% in the neurosurgeon group and n=44, 63.8% in the neurologist group). The neurosurgeon group achieved a shorter door-to-puncture time than the neurologist group (median, 115 minutes; IQR, 107–151 vs. median, 162 minutes; IQR, 117–189; p=0.049). Good clinical outcomes (3-month modified Rankin Scale 0–2) did not differ significantly between the two groups (96/119 [80.7%] vs. 322/417 [77.2%], p=0.454).
Conclusion
: The neurosurgeon group showed similar door-to-treatment time and clinical outcomes to the neurologist group in patients with AIS in the ER. This study suggests that neurosurgeons have comparable abilities to care for patients with AIS in the ER.

Keyword

Ischemic stroke; Neurosurgeons; Neurologists; Emergency; Treatment

Figure

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  Fig. 1. The case accrual process. ER : emergency room, DWI : diffusion-weighted imaging, NS : neurosurgery, NR : neurology.

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  Fig. 2. National Institute of Health Stroke Scale (NIHSS) scores on admission for all patients, neurosurgeon group, and neurologist group.

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  Fig. 3. Three-month modified Rankin Scale (mRS) scores for all patients, neurosurgeon group, and neurologist group.

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  Fig. 4. Treatment types for all patients, neurosurgeon group, and neurologist group. Tx : treatment, tPA : tissue plasminogen activator, MT : mechanical thrombectomy.

Reference

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