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 reco gnition and treatment of acute stroke. Critical to this goal is the educati on 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 quest ionnaire on stroke and the treatment of carotid stenosis. RESULTS: Of the 266 respondents, 76% had heard of the "brain attack" campai gn, 22% did not identify dysarthria as a symptom of stroke, and 21% did not identify obtundation as a presentation of stroke. Twenty-eight percent cho se not to use tissue plasminogen activator for acute ischemic stroke, and 6 0% 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 adv ocate operating on patients with asymptomatic severe stenosis (>70%) until stenosis reached a critical value (85%). Conversely, 45% would recommend op erative treatment for symptomatic patients who had less than 60% stenosis. Sixty-eight percent would refer patients to vascular surgeons, 14% to neuro surgeons, and 17% to both for carotid endarterectomy. CONCLUSION: Recognition of stroke as a medical emergency is improving. Howe ver, significant progress can still be made in the recognition of stroke sy mptoms. 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 c ould promote the aggressive treatment of asymptomatic patients to prevent s troke.