Lee Sang Hyuk, Nam Taek Min, Jang Ji Hwan, Kim Young Zoon, Kim Kyu Hong, Ryu Kyeong Hwa, Kim Do-Hyung, Kwan Byung Soo, Lee Hyungon, Kim Seung Hwan
Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
J Korean Neurosurg Soc. 2023 Jan;66(1):24-32. doi: 10.3340/jkns.2022.0085. Epub 2022 Aug 17.
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.
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%).
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).
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.
随着近期急性缺血性卒中（AIS）机械取栓术（MT）的增加，神经外科医生在AIS治疗中的作用变得越来越重要。本研究旨在评估韩国一家三级医院急诊科中由神经外科医生和神经内科医生治疗的AIS患者的治疗结果。
2020年1月至2021年6月，536例症状发作24小时内的AIS患者通过急诊科入院。根据在急诊科为AIS提供初始治疗的医生类型，患者分为两组：（a）神经外科医生组（n = 119，22.2%）和（b）神经内科医生组（n = 417，77.8%）。
536例患者中有82例（15.3%）接受了静脉注射组织型纤溶酶原激活剂（tPA）治疗（神经外科医生组17例[14.3%]，神经内科医生组65例[15.6%]）。两组之间从就诊到使用tPA的时间无显著差异（中位数，53分钟；四分位间距[IQR]，45 - 58分钟与中位数，54分钟；IQR，46 - 74分钟；p = 0.372）。69例患者（12.9%）接受了MT治疗（神经外科医生组25例，36.2%；神经内科医生组44例，63.8%）。神经外科医生组从就诊到穿刺的时间比神经内科医生组短（中位数，115分钟；IQR，107 - 151分钟与中位数，162分钟；IQR，117 - 189分钟；p = 0.049）。两组之间良好的临床结局（3个月改良Rankin量表评分0 - 2分）无显著差异（96/119 [80.7%] 对比322/417 [77.2%]，p = 0.454）。
在急诊科的AIS患者中，神经外科医生组与神经内科医生组的就诊到治疗时间及临床结局相似。本研究表明神经外科医生在急诊科对AIS患者的治疗能力相当。
