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Physician awareness of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Saudi Arabia and the Gulf countries
OBJECTIVES: To explore the perspective on Decompressive craniectomy (DH) of each of these specialties to establish common grounds for improved clinical practice. METHOD: An electronic survey was distributed via email and social media groups to members of these specialties in Kingdom of Saudi Arabia...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Riyadh : Armed Forces Hospital
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015448/ https://www.ncbi.nlm.nih.gov/pubmed/29664455 http://dx.doi.org/10.17712/nsj.2018.2.20170148 |
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author | Al-Jehani, Hosam M. Alsharydah, Abdulaziz Rammal, Seba A. Baeesa, Saleh S. Mekhlafi, Mohammad |
author_facet | Al-Jehani, Hosam M. Alsharydah, Abdulaziz Rammal, Seba A. Baeesa, Saleh S. Mekhlafi, Mohammad |
author_sort | Al-Jehani, Hosam M. |
collection | PubMed |
description | OBJECTIVES: To explore the perspective on Decompressive craniectomy (DH) of each of these specialties to establish common grounds for improved clinical practice. METHOD: An electronic survey was distributed via email and social media groups to members of these specialties in Kingdom of Saudi Arabia and the Gulf countries. Local practices, common triggers for referral for DH, perceived outcomes of these procedures, individual impression of what constitutes good clinical outcomes were explored. RESULTS: There are 89 physicians participated: 41 (46.1%) neurologists, 34 (38.2%) neurosurgeons, and 14 (15.7%) intensivests. Participants are mostly practicing in intermediate volume centers or high volume centers. Half of the neurosurgeons preferred to be consulted immediately on candidates with large middle cerebral artery (MCA) strokes. The most important referral trigger for DH was clinical changes. The modified Rankin Scale (mRS) cutoff for good clinical outcome was 3 for 73.6% of respondents. There was agreement that DH only improves survival (64.4%). A third of the neurologists considered it to improve functional outcome compared to 15.4% of intensivests and 14.8% of neurosurgeons. There was agreement (66.7%) that patients older than 60 years with involvement of more than one territory should be excluded from DH. Only 7.7% of neurosurgeons excluded patients with dominant hemispheric strokes. CONCLUSION: Our physicians’ views are variable in what’s called acceptable outcome, and further studies are needed to to test the characteristics that helps in decision making such as hemisphere dominancy, time onset of stroke and vital radiological signs. This is seen despite the literature being full of data that supports the DC over medical management in malignant MCA infarction. Better multidisciplinary education initiatives are needed to unify the understanding and help improve the practices in this challenging subset of patients. |
format | Online Article Text |
id | pubmed-8015448 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Riyadh : Armed Forces Hospital |
record_format | MEDLINE/PubMed |
spelling | pubmed-80154482021-08-13 Physician awareness of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Saudi Arabia and the Gulf countries Al-Jehani, Hosam M. Alsharydah, Abdulaziz Rammal, Seba A. Baeesa, Saleh S. Mekhlafi, Mohammad Neurosciences (Riyadh) Original Article OBJECTIVES: To explore the perspective on Decompressive craniectomy (DH) of each of these specialties to establish common grounds for improved clinical practice. METHOD: An electronic survey was distributed via email and social media groups to members of these specialties in Kingdom of Saudi Arabia and the Gulf countries. Local practices, common triggers for referral for DH, perceived outcomes of these procedures, individual impression of what constitutes good clinical outcomes were explored. RESULTS: There are 89 physicians participated: 41 (46.1%) neurologists, 34 (38.2%) neurosurgeons, and 14 (15.7%) intensivests. Participants are mostly practicing in intermediate volume centers or high volume centers. Half of the neurosurgeons preferred to be consulted immediately on candidates with large middle cerebral artery (MCA) strokes. The most important referral trigger for DH was clinical changes. The modified Rankin Scale (mRS) cutoff for good clinical outcome was 3 for 73.6% of respondents. There was agreement that DH only improves survival (64.4%). A third of the neurologists considered it to improve functional outcome compared to 15.4% of intensivests and 14.8% of neurosurgeons. There was agreement (66.7%) that patients older than 60 years with involvement of more than one territory should be excluded from DH. Only 7.7% of neurosurgeons excluded patients with dominant hemispheric strokes. CONCLUSION: Our physicians’ views are variable in what’s called acceptable outcome, and further studies are needed to to test the characteristics that helps in decision making such as hemisphere dominancy, time onset of stroke and vital radiological signs. This is seen despite the literature being full of data that supports the DC over medical management in malignant MCA infarction. Better multidisciplinary education initiatives are needed to unify the understanding and help improve the practices in this challenging subset of patients. Riyadh : Armed Forces Hospital 2018-04 /pmc/articles/PMC8015448/ /pubmed/29664455 http://dx.doi.org/10.17712/nsj.2018.2.20170148 Text en Copyright: © Neurosciences https://creativecommons.org/licenses/by-nc-sa/3.0/Neurosciences is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work. |
spellingShingle | Original Article Al-Jehani, Hosam M. Alsharydah, Abdulaziz Rammal, Seba A. Baeesa, Saleh S. Mekhlafi, Mohammad Physician awareness of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Saudi Arabia and the Gulf countries |
title | Physician awareness of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Saudi Arabia and the Gulf countries |
title_full | Physician awareness of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Saudi Arabia and the Gulf countries |
title_fullStr | Physician awareness of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Saudi Arabia and the Gulf countries |
title_full_unstemmed | Physician awareness of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Saudi Arabia and the Gulf countries |
title_short | Physician awareness of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Saudi Arabia and the Gulf countries |
title_sort | physician awareness of decompressive hemicraniectomy for malignant middle cerebral artery infarction in saudi arabia and the gulf countries |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015448/ https://www.ncbi.nlm.nih.gov/pubmed/29664455 http://dx.doi.org/10.17712/nsj.2018.2.20170148 |
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