Association between time to emergency neurosurgery and clinical outcomes for spontaneous hemorrhagic stroke: A nationwide observational study

Abstract

Objective Spontaneous hemorrhagic stroke is a devastating disease with high mortality and grave neurological outcomes worldwide. This study aimed to evaluate the association between the elapsed time from emergency department (ED) visit to emergency neurosurgery and clinical outcomes in patients with spontaneous hemorrhagic stroke. Methods A nationwide cross-sectional study was conducted using the nationwide emergency database in Korea. Spontaneous hemorrhagic stroke patients who received neurosurgery within 12 hours of ED visit between January 2018 and December 2019 were enrolled. The main exposure was time to neurosurgery and the primary outcome was in-hospital mortality. Multivariable logistic regression was conducted. Results Among 2,602 study populations (incidence rate: 2.5 per 100,000 person-years, 15.8% of SAH, 78.6% of ICH, and 5.6% of mixed type), 525 (20.2%) patients received surgery in the ultra-early (0–2 hours) group, 1,093 (42.0%) in the early (2–4 hours) group, and 984 (37.8%) in the late (4–12 hours) group. The early group showed better survival outcomes than the ultra-early and late group (in-hospital mortality 22.2% vs. 26.5% and 26.1%, p = 0.06). Compared to the late group, adjusted OR (95% CI) for in-hospital mortality was 0.78 (0.63–0.96) for the early group, while there was no significant difference in the ultra-early group (0.90 (0.69–1.16)). Conclusions Early neurosurgery within 2–4 hours of the ED visit was associated with favorable survival outcomes in patients with spontaneous hemorrhagic stroke.

The Secretome of Mesenchymal Stromal Cells in Treating Intracerebral Hemorrhage: The First Step to Bedside

“…In our study, we have shown that MSC secretome, when administered intravenously within 1 h after modeling the intracerebral hemorrhage, provides a better outcome in the experimental animals with the least severity of neurological disorders and the least brain lesion volume. This correlates with the literature data available, the so-called stroke golden hour-60 min after a stroke when the effectiveness of neuroprotection is maximum [51,52]. With an increase in the time interval between the modeling of intracerebral hemorrhage and intravenous administration of MSC secretome (from 1 to 6 h), the effectiveness of neuroprotection decreased, which correlated with literature data [49][50][51][52] and manifested in the worse neurological outcome and larger lesion volume in the brain tissue.…”

“…This correlates with the literature data available, the so-called stroke golden hour-60 min after a stroke when the effectiveness of neuroprotection is maximum [51,52]. With an increase in the time interval between the modeling of intracerebral hemorrhage and intravenous administration of MSC secretome (from 1 to 6 h), the effectiveness of neuroprotection decreased, which correlated with literature data [49][50][51][52] and manifested in the worse neurological outcome and larger lesion volume in the brain tissue.…”

Epidemiology of stroke in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022

“…However, the dura-tion from symptom onset to ED visit increased with the increase in age. Earlier admission and early neurosurgical intervention were associated with favorable outcomes in acute ischemic stroke and spontaneous hemorrhagic stroke [13,14]. Several stroke recognition systems and educational programs have been developed and implemented in prehospital settings [15].…”

Using an Artificial Intelligence Application Expedited ENRICH Trial Patient Screening: A Single Center Experience

“…The mantra “time is brain” is also certainly true for ischemic stroke, but it may also be applicable to intracerebral hemorrhage given that hematoma expansion occurs in over 70% of patients during the first 24 hours and may lead to increased morbidity and mortality 6,7 . Clinically significant hematoma expansion typically occurs early in the patient’s clinical course 8 .…”