Treating stroke as a medical emergency: a survey of resident physicians' attitudes toward "brain attack" and carotid endarterectomy.
OBJECTIVE
A major impetus of the "brain attack" campaign is the early recognition and treatment of acute stroke. Critical 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.


CONCLUSIONS
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.
Wang
M Y
MY
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles 90033, USA. myw@hsc.usc.edu
Lavine
S D
SD
Soukiasian
H
H
Tabrizi
R
R
Levy
M L
ML
Giannotta
S L
SL
D001291:Attitude of Health Personnel; D002339:Carotid Arteries / Q000601:surgery*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000628:therapy; D003625:Data Collection; D004632:Emergency Medical Services; D004691:Endarterectomy; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007396:Internship and Residency; D012017:Referral and Consultation; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator