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Impact of the Dedicated Neurointensivists on the Outcome in Patients with Ischemic Stroke Based on the Linked Big Data for Stroke in Korea

Journal of Korean Medical Science 2020년 35권 21호 p.135 ~ 135
김대중, 이지성, Yoon Jae-Sun, 오미선, 김지우, 정건화, 유경호, 이병철, 고상배, 윤벙우,
소속 상세정보
김대중 ( Kim Tae-Jung ) - Seoul National University Hospital Department of Neurology
이지성 ( Lee Ji-Sung ) - University of Ulsan College of Medicine Asan Medical Center Clinical Research Center
 ( Yoon Jae-Sun ) - Seoul National University Hospital Department of Neurology
오미선 ( Oh Mi-Sun ) - Hallym University Sacred Heart Hospital Department of Neurology
김지우 ( Kim Ji-Woo ) - Health Insurance Review and Assessment Service
정건화 ( Jung Keun-Hwa ) - Seoul National University Hospital Department of Neurology
유경호 ( Yu Kyung-Ho ) - Hallym University Sacred Heart Hospital Department of Neurology
이병철 ( Lee Byung-Chul ) - Hallym University Sacred Heart Hospital Department of Neurology
고상배 ( Ko Sang-Bae ) - Seoul National University Hospital Department of Neurology
윤벙우 ( Yoon Byung-Woo ) - Seoul National University Hospital Department of Neurology

Abstract


Background: Neurocritical care by dedicated neurointensivists may improve outcomes of critically ill patients with severe brain injury. In this study, we aimed to validate whether neurointensive care could improve the outcome in patients with critically ill acute ischemic stroke using the linked big dataset on stroke in Korea.

Methods: We included 1,405 acute ischemic stroke patients with mechanical ventilator support in the intensive care unit after an index stroke. Patients were retrieved from linking the Clinical Research Center for Stroke Registry and the Health Insurance Review and Assessment Service data from the period between January 2007 and December 2014. The outcomes were mortality at discharge and at 3 months after an index stroke. The main outcomes were compared between the centers with and without dedicated neurointensivists.

Results: Among the included patients, 303 (21.6%) were admitted to the centers with dedicated neurointensivists. The patients treated by dedicated neurointensivists had significantly lower in-hospital mortality (18.3% vs. 26.8%, P = 0.002) as well as lower mortality at 3-month (38.0% vs. 49.1%, P < 0.001) than those who were treated without neurointensivists. After adjusting for confounders, a treatment without neurointensivists was independently associated with higher in-hospital mortality (odds ratio [OR], 1.59; 95% confidence intervals [CIs], 1.13?2.25; P = 0.008) and 3-month mortality (OR, 1.48; 95% CIs, 1.12?1.95; P = 0.005).

Conclusion: Treatment by dedicated neurointensivists is associated with lower in-hospital and 3-month mortality using the linked big datasets for stroke in Korea. This finding stresses the importance of neurointensivists in treating patients with severe ischemic stroke.

키워드

Ischemic Stroke; Neurointensivist; Neurocritically Ill Patients; Outcome; Big Data

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