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

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.

The Allure of Big Data to Improve Stroke Outcomes: Review of Current Literature

“…Similar to earlier reviews [4], stroke severity was identified as an important clinical predictor of mortality post-stroke [9,12,15]. Patients with less severe ICH, i.e., able to walk independently on admission, had about fourfold reduced risk of 180-day mortality than those with more severe ICH [21•].…”

“…Data on mortality after stroke were reported in 28 studies (n = 1,367 to 86,189 individuals) from 14 countries (Australia, Belgium, Canada, Denmark, France, Germany, Hong Kong, Italy, Korea, Netherlands, Norway, Sweden, UK, and USA) [8 •, 9, 10, 11 In these studies, mortality was ascertained using hospital administrative data [26, 27, 30••, 33], death registers [8•, 9, 10, 11 , or a combination of linkage with death registers and prospective follow-up assessments [12]. Cumulative crude rates of mortality post-stroke/TIA ranged from 7 to 18% within 30 days [9, 11••, 16, 20, 26] and 14 to 28% within 1 year [8••, 10••, 11••, 13,20,36].…”

“…A number of healthcare factors have been associated with improved survival after stroke/TIA. Receiving neurointervention following admission for stroke was associated with a 12% reduced risk of 3-month mortality [12], whereas early (vs. delayed) direct enteral feeding tube placement after acute stroke improved 30-day survival [25]. Using data from twelve hospitals in the USA, provision of one to two occupational or physical therapy sessions during admission for acute stroke was associated with a 30% reduced risk of 30-day mortality or readmission [26].…”

“…Stroke severity is one of the most important factors for predicting outcomes post-stroke [9,12,15], but information on this measure is often unavailable in big datasets. In the Australian Stroke Clinical Registry, information is routinely collected on a patient's ability to walk independently on admission to provide a simple, validated marker of stroke severity that is predictive of 30-day mortality and mRS scores [39,72].…”

Association of Neurocritical Care Services With Mortality and Functional Outcomes for Adults With Brain Injury

“…After 5659 nonduplicated published records were screened, 26 studies fulfilled the inclusion criteria (eFigure 1 in the Supplement). Eight studies were excluded following full-text assessment for eligibility (eTable 2 in the Supplement). Eight studies were excluded that were previously included in past systematic reviews (eTable 3 in the Supplement).…”