Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
PLoS One. 2022 Apr 28;17(4):e0267856. doi: 10.1371/journal.pone.0267856. eCollection 2022.
Spontaneous hemorrhagic stroke is a devastating disease with high mortality and grave neurological outcomes worldwide. This study aimed to evaluate the association between the elapsed time from emergency department (ED) visit to emergency neurosurgery and clinical outcomes in patients with spontaneous hemorrhagic stroke.
A nationwide cross-sectional study was conducted using the nationwide emergency database in Korea. Spontaneous hemorrhagic stroke patients who received neurosurgery within 12 hours of ED visit between January 2018 and December 2019 were enrolled. The main exposure was time to neurosurgery and the primary outcome was in-hospital mortality. Multivariable logistic regression was conducted.
Among 2,602 study populations (incidence rate: 2.5 per 100,000 person-years, 15.8% of SAH, 78.6% of ICH, and 5.6% of mixed type), 525 (20.2%) patients received surgery in the ultra-early (0-2 hours) group, 1,093 (42.0%) in the early (2-4 hours) group, and 984 (37.8%) in the late (4-12 hours) group. The early group showed better survival outcomes than the ultra-early and late group (in-hospital mortality 22.2% vs. 26.5% and 26.1%, p = 0.06). Compared to the late group, adjusted OR (95% CI) for in-hospital mortality was 0.78 (0.63-0.96) for the early group, while there was no significant difference in the ultra-early group (0.90 (0.69-1.16)).
Early neurosurgery within 2-4 hours of the ED visit was associated with favorable survival outcomes in patients with spontaneous hemorrhagic stroke.
自发性脑出血是一种具有高死亡率和严重神经后果的全球性破坏性疾病。本研究旨在评估急诊就诊至紧急神经外科手术的时间间隔与自发性脑出血患者的临床结局之间的关系。
本研究使用韩国全国急诊数据库进行了一项全国性的横断面研究。纳入了在急诊就诊后 12 小时内接受神经外科手术的自发性脑出血患者。主要暴露因素为神经外科手术时间，主要结局为住院死亡率。采用多变量逻辑回归进行分析。
在 2602 例研究人群中（发病率：每 100000 人年 2.5 例，蛛网膜下腔出血占 15.8%，脑实质出血占 78.6%，混合型占 5.6%），525 例（20.2%）患者在超早期（0-2 小时）组接受手术，1093 例（42.0%）在早期（2-4 小时）组接受手术，984 例（37.8%）在晚期（4-12 小时）组接受手术。早期组的生存结局优于超早期组和晚期组（住院死亡率分别为 22.2%、26.5%和 26.1%，p=0.06）。与晚期组相比，早期组的住院死亡率调整后比值比（95%CI）为 0.78（0.63-0.96），而超早期组无显著差异（0.90（0.69-1.16））。
在急诊就诊后 2-4 小时内进行早期神经外科手术与自发性脑出血患者的生存结局改善相关。
