Madhok Debbie Y, Diaz Michael A, Darger Bryan F, Wybourn Christopher, Singh Vineeta
Department of Emergency Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California; Department of Neurology, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California.
Department of Neurology, University of California, San Francisco, San Francisco, California.
J Emerg Med. 2019 Oct;57(4):543-549. doi: 10.1016/j.jemermed.2019.05.025. Epub 2019 Jul 31.
It is speculated that there is overlap between neurologic emergencies and trauma, yet to date there has not been a study looking at the prevalence of neurologic emergencies amongst trauma activations.
We sought to determine the prevalence of neurologic emergencies in patients presenting to a level I trauma center as trauma team activations (TTAs). We explored a subset of acute ischemic stroke patients to determine delays in management.
This was a retrospective review of trauma registry data capturing all TTAs at a level I trauma and stroke center from 2011 to 2016. Neurologic emergencies were defined as ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or status epilepticus. Among patients diagnosed with acute ischemic strokes, we compared stroke metrics with hospital stroke data during the same period.
There were 18,859 trauma activations during the study period, of which 117 (0.6%) had a neurologic emergency. There were 52 patients with ischemic stroke (45%), 39 with intracerebral hemorrhage (34%), 15 with subarachnoid hemorrhage (13%), and 10 with status epilepticus (9%). Among the 52 patients with ischemic stroke, 20 (38%) received intravenous thrombolysis. The median time to computed tomography scan was 23 min and the median time to thrombolysis (tissue plasminogen activator) was 60 min. When compared with non-TTA patients during the same time period, both median time to computed tomography scan and time to tissue plasminogen activator were similar (p = 0.16 and p = 0.6, respectively).
Neurologic emergencies, though relatively uncommon, do exist among TTAs. Despite the TTA, eligible patients met the benchmarks for acute stroke care delivery.
据推测，神经科急症与创伤之间存在重叠，但迄今为止，尚未有研究探讨创伤激活病例中神经科急症的发生率。
我们试图确定在一级创伤中心因创伤团队激活（TTA）而就诊的患者中神经科急症的发生率。我们对一部分急性缺血性脑卒中患者进行了研究，以确定治疗延迟情况。
这是一项对创伤登记数据的回顾性研究，涵盖了2011年至2016年期间一级创伤和卒中中心的所有TTA。神经科急症定义为缺血性脑卒中、脑出血、蛛网膜下腔出血或癫痫持续状态。在诊断为急性缺血性脑卒中的患者中，我们将卒中指标与同期医院卒中数据进行了比较。
研究期间共有18859次创伤激活，其中117例（0.6%）患有神经科急症。有52例缺血性脑卒中患者（45%），39例脑出血患者（34%），15例蛛网膜下腔出血患者（13%），10例癫痫持续状态患者（9%）。在52例缺血性脑卒中患者中，20例（38%）接受了静脉溶栓治疗。计算机断层扫描的中位时间为23分钟，溶栓（组织纤溶酶原激活剂）的中位时间为60分钟。与同期非TTA患者相比，计算机断层扫描的中位时间和组织纤溶酶原激活剂的时间相似（分别为p = 0.16和p = 0.6）。
神经科急症在TTA中虽然相对不常见，但确实存在。尽管有TTA，但符合条件的患者达到了急性卒中治疗的标准。
