Intravenous Tissue Plasminogen Activator Administration in Community Hospitals Facilitated by Telestroke Service-猫眼课题宝

DOI：

10.1227/neu.0000000000000073

发表时间：

2013-10-01

期刊：

NEUROSURGERY

影响因子：

4.8

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Chalouhi, Nohra;Dressler, Jeremy A.;Tjoumakaris, Stavropoula

背景：在美国，中风是导致死亡和残疾的主要原因。尽管静脉注射组织型纤溶酶原激活剂(IV-tPA)已得到证实，但只有一小部分中风患者(3.4%-5.2%)接受了美国食品和药物管理局(FDA)批准的这种疗法。目的：前瞻性地评估远程中风网络对社区医院急性缺血性中风患者IV-tPA使用率的影响。方法：托马斯·杰斐逊大学医院开发了一种远程中风系统，在该地区的28家社区医院(宾夕法尼亚州、新泽西州和特拉华州)提供急性中风护理。远程医疗会诊是通过远程呈现机器人技术提供的。结果：2011年1月至2012年6月，共提供远程医疗卒中会诊1643例。从咨询请求到远程医疗响应的平均间隔时间为12.0分钟。在所有中风咨询中，静脉注射tPA的总体使用率为14%。共有237名患者(14.4%)被确定为符合静脉溶栓治疗条件。其中，97%接受了静脉注射tPA。远程医疗计划中的大多数医院(82%)报告IV-tPA使用增加(平均增加55%)。远程会诊后转到初级卒中中心的患者比例从2011年前两个季度的44%下降到2012年前两个季度的19%(P&lt；.001)。结论：实施远程卒中系统有助于在相对较短的时间内在社区医院卒中患者的高静脉溶栓率。这些结果高于全国平均水平(3.4%-5.2%)，并支持在服务不足的地区实施远程中风网络，以便更广泛地获得中风专业知识。

BACKGROUND: Stroke is a leading cause of death and disability in the United States. Despite the proven benefits of intravenous tissue plasminogen activator (IV-tPA), only a small percentage of patients who have had a stroke (3.4%-5.2%) receive this US Food and Drug Administration-approved therapy.OBJECTIVE: To prospectively assess the impact of a telestroke network on the rate of IV-tPA administration in patients with acute ischemic stroke in community hospitals.METHODS: Thomas Jefferson University Hospital has developed a telestroke system providing acute stroke care in 28 community hospitals within the region (Pennsylvania, New Jersey, and Delaware). Telemedicine consultations are delivered through Remote Presence robotic technology.RESULTS: A total of 1643 telemedicine stroke consultations were provided between January 2011 and June 2012. The mean interval from consultation request to telemedicine response was 12.0 minutes. The overall rate of IV-tPA use was 14% among all stroke consultations. A total of 237 patients (14.4%) were determined to be eligible for intravenous thrombolysis. Of those, 97% received IV-tPA. Most hospitals (82%) within the telemedicine program reported an increase in IV-tPA use (mean increase, 55%). The proportion of patients transferred to a primary stroke center after teleconsultation decreased from 44% in the first 2 quarters of 2011 to 19% in the first 2 quarters of 2012 (P < .001).CONCLUSION: Implementing a telestroke system facilitates high rates of intravenous thrombolysis in patients who have had a stroke in community hospitals within a relatively short time frame. These results are higher than the national average rate (3.4%-5.2%) and support the implementation of telestroke networks for wider access to stroke expertise in underserved regions.

Intravenous Tissue Plasminogen Activator Administration in Community Hospitals Facilitated by Telestroke Service

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