Treating stroke as a medical emergency

A survey of resident physicians' attitudes toward "brain attack" and carotid endarterectomy

Michael Y. Wang, Sean D. Lavine, Harmik Soukiasian, Robert Tabrizi, Michael L. Levy, Steven L. Giannotta

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

OBJECTIVE: A major impetus of the "brain attack" campaign is the early recognition and treatment of acute stroke. Criticai to this goal is the education of physicians during their residency training. METHODS: Resident physicians in Los Angeles who were in family practice (18%), internal medicine (51%), emergency medicine (20%), and neurology (11%) and had already completed their first year of training responded to a questionnaire on stroke and the treatment of carotid stenosis. RESULTS: Of the 266 respondents, 76% had heard of the "brain attack" campaign, 22% did not identify dysarthria as a symptom of stroke, and 21% did not identify obtundation as a presentation of stroke. Twenty-eight percent chose not to use tissue plasminogen activator for acute ischemic stroke, and 60% recognized the need to begin treatment within 3 hours. More than 90% of respondents were able to identify correct screening tests for patients with suspected carotid stenosis. However, 56% responded that they would not advocate operating on patients with asymptomatic severe stenosis (>70%) until stenosis reached a critical value (85%). Conversely, 45% would recommend operative treatment for symptomatic patients who had less than 60% stenosis. Sixty-eight percent would refer patients to vascular surgeons, 14% to neurosurgeons, and 17% to both for carotid endarterectomy. CONCLUSION: Recognition of stroke as a medical emergency is improving. However, significant progress can still be made in the recognition of stroke symptoms. Primary care and neurology residents remain skeptical about carotid endarterectomy for asymptomatic patients, whereas there is enthusiasm for treating stroke survivors. Education by members of the surgical community could promote the aggressive treatment of asymptomatic patients to prevent stroke.

Original languageEnglish
Pages (from-to)1109-1117
Number of pages9
JournalNeurosurgery
Volume48
Issue number5
StatePublished - May 3 2001
Externally publishedYes

Fingerprint

Carotid Endarterectomy
Emergencies
Stroke
Physicians
Brain
Pathologic Constriction
Carotid Stenosis
Neurology
Therapeutics
Education
Surveys and Questionnaires
Dysarthria
Los Angeles
Family Practice
Emergency Medicine
Tissue Plasminogen Activator
Internship and Residency
Internal Medicine
Blood Vessels
Survivors

Keywords

  • Brain attack
  • Carotid endarterectomy
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Wang, M. Y., Lavine, S. D., Soukiasian, H., Tabrizi, R., Levy, M. L., & Giannotta, S. L. (2001). Treating stroke as a medical emergency: A survey of resident physicians' attitudes toward "brain attack" and carotid endarterectomy. Neurosurgery, 48(5), 1109-1117.

Treating stroke as a medical emergency : A survey of resident physicians' attitudes toward "brain attack" and carotid endarterectomy. / Wang, Michael Y.; Lavine, Sean D.; Soukiasian, Harmik; Tabrizi, Robert; Levy, Michael L.; Giannotta, Steven L.

In: Neurosurgery, Vol. 48, No. 5, 03.05.2001, p. 1109-1117.

Research output: Contribution to journalArticle

Wang, MY, Lavine, SD, Soukiasian, H, Tabrizi, R, Levy, ML & Giannotta, SL 2001, 'Treating stroke as a medical emergency: A survey of resident physicians' attitudes toward "brain attack" and carotid endarterectomy', Neurosurgery, vol. 48, no. 5, pp. 1109-1117.
Wang MY, Lavine SD, Soukiasian H, Tabrizi R, Levy ML, Giannotta SL. Treating stroke as a medical emergency: A survey of resident physicians' attitudes toward "brain attack" and carotid endarterectomy. Neurosurgery. 2001 May 3;48(5):1109-1117.
Wang, Michael Y. ; Lavine, Sean D. ; Soukiasian, Harmik ; Tabrizi, Robert ; Levy, Michael L. ; Giannotta, Steven L. / Treating stroke as a medical emergency : A survey of resident physicians' attitudes toward "brain attack" and carotid endarterectomy. In: Neurosurgery. 2001 ; Vol. 48, No. 5. pp. 1109-1117.
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