Journal article
A comparison of two stroke cohorts cared for by two different specialties in a practice-based tele-stroke population
Clinical neurology and neurosurgery, Vol.168, pp.67-71
05/2018
DOI: 10.1016/j.clineuro.2018.02.033
PMID: 29525730
Abstract
•Neurovascular surgeons are playing an increasingly important role in the management and overall care of acute ischemic stroke.•Acute ischemic stroke requires a multidisciplinary management.•Care provided by neurosurgeons has similar efficacy as the care provided by neurologists.
Neurologists have continually led the assessment and management of Acute Ischemic Stroke(AIS) by use of IV-rtPA, anti-platelet therapy, antihypertensives, and other pharmacologic agents. Since the advent of mechanical thrombectomy(MT) and its proven efficacy, neurovascular surgeons(NS) are playing an increasingly important role in the management and overall care of AIS. We assessed outcomes of AIS patients managed by NS, who have been traditionally managed by neurologists.
Outcomes of AIS patients who presented to the telestroke system, over a 5-year period, were assessed. NIHSS and mRS stroke scales were used as outcome metrics. Multivariate analysis was conducted to compare outcomes of patients treated by neurovascular surgeons and those treated by neurologists.
1353 AIS patients were identified. 21.6% received care from neurosurgeons and 78.4% received care from neurologists. Of the neurologist-managed group: 7.8% received MT and were followed by NS, 34% received IVrt-PA, average discharge NIHSS = 9.0 (SD = 8.42), latest follow-up mRS < 2 = 57.5% and mortality rate = 9.4%. Of the neurovascular surgeon-managed group: 7.4% patients received MT, 20% received IVrt-PA, average discharge NIHSS = 0.14(SD = 0.72), latest follow-up mRS ≤2 = 98.6% and mortality rate = 8.3%. There were no significant differences between groups in MT use (OR 1.22; CI95%, 0.971–2.09; p = 0.464), IVrt-PA administration (OR 0.98; CI95%, 0.70–1.38; p = 0.924), mortality rate (OR 1.21; 0.71–2.03; p = 0.483) and patients’ latest mRS, p = 0.873.
AIS requires multidisciplinary management. Care provided by neurosurgeons has similar efficacy and patient outcomes as the care provided by neurologists. These findings support the role and ability of neurosurgeons to manage and care for these patients.
Details
- Title: Subtitle
- A comparison of two stroke cohorts cared for by two different specialties in a practice-based tele-stroke population
- Creators
- Elias Atallah - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USAKimon Bekelis - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USAHassan Saad - Department of Neurosurgery, Arkansas Institute of Neurosciences, Little Rock, AR, USANohra Chalouhi - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USASophia Dang - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USAJonathan Li - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USAAyan Kumar - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USAJustin Turpin - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USARanda Barsoom - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USAStavropoula Tjoumakaris - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USADavid Hasan - Departement of Neurosurgery, University of Iowa, Hawkins Drive Iowa City, Iowa, USAMaureen Deprince - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USAGiuliana Labella - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USARobert H Rosenwasser - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USAPascal Jabbour - Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
- Resource Type
- Journal article
- Publication Details
- Clinical neurology and neurosurgery, Vol.168, pp.67-71
- Publisher
- Elsevier B.V
- DOI
- 10.1016/j.clineuro.2018.02.033
- PMID
- 29525730
- ISSN
- 0303-8467
- eISSN
- 1872-6968
- Language
- English
- Date published
- 05/2018
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurosurgery; Otolaryngology
- Record Identifier
- 9984040389002771
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