Using Telemedicine to Facilitate Thrombolytic Therapy for Patients with Acute Stroke
Using Telemedicine to Facilitate Thrombolytic Therapy for Patients with Acute Stroke
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DOI：
10.1016/s1553-7250(06)32025-9
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发表时间：
2006-04-01
影响因子：
2.3
通讯作者：
Grotta, James C.
中科院分区：
文献类型：
--
作者：
Choi, John Y.;Porche, Nichole A.;Grotta, James C.
背景资料：最近的卒中护理要求指出，如果符合适当的纳入和排除标准，所有卒中患者都应接受静脉重组组织纤溶酶原激活剂（rt-PA）筛查和治疗。休斯顿以东90-130英里的两家社区医院部署了远程医疗（视频会议），以提供急性中风咨询服务。发展远程医疗能力：根据脑攻击联盟的建议，神经外科服务需要在两小时内提供。鉴于其不完整的神经病学覆盖范围，远程医院将远程医疗确定为最佳选择，德克萨斯大学休斯顿健康科学中心中风团队作为专业知识的提供者。在远程医疗项目之前的13个月里，（2003年1月至2004年3月），2（0.8%）的327例患者接受了rt-PA治疗，（4.3%）的328例患者在远程医疗项目（2004年4月至2005年5月），p = 4点改善中风量表在治疗后24小时。3例患者在24小时评估期间恶化。无脑内血肿发生。上门到针的平均时间为85分钟（范围，27-165分钟）。讨论：远程医疗促进了急性中风患者的溶栓治疗，其目的不是取代远程医疗提供者提供的护理，而是解决时间和空间相关的紧急需求。
Background: Recent stroke-care requirements state that all stroke patients should be screened for intravenous recombinant tissue plasminogen activator (rt-PA) and treated, if the appropriate inclusion and exclusion criteria are met. Two community hospitals 90-130 miles east of Houston deployed telemedicine (videoteleconferencing) to provide acute stroke consultative services.Developing a Telemedicine Capacity: According to the Brain Attack Coalition's recommendations, neurosurgical services need to be accessible within two hours. Given their incomplete neurology coverage, the remotesite hospitals identified telemedicine as the best option, with the University of Texas Health Science Center at Houston stroke team as the provider of expertise.Results: In the 13 months preceding the telemedicine project (January 2003-March 2004), 2 (.8%) of 327 patients received rt-PA, compared with 14 (4.3%) of 328 patients during the telemedicine project (April 2004-May 2005), p = 4 points improvement in a stroke scale at 24 hours posttreatment. Three patients worsened during the 24-hour assessment. No intracerebral hemorrhages occurred. Door-to-needle median time was 85 minutes (range, 27-165 minutes).Discussion: Telemedicine facilitated thrombolytic therapy for acute stroke patients and is intended not to replace care provided by remote-site providers but rather to address a time-and spatially related emergency need.