Outcomes Among Patients With Ischemic Stroke Treated With Intravenous tPA (Tissue-Type Plasminogen Activator) via Telemedicine.
Outcomes Among Patients With Ischemic Stroke Treated With Intravenous tPA (Tissue-Type Plasminogen Activator) via Telemedicine.
复制标题
通过远程医疗静脉注射 tPA（组织型纤溶酶原激活剂）治疗缺血性中风患者的结果。
DOI：
10.1161/strokeaha.118.024703
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发表时间：
2019
期刊：
影响因子：
8.3
通讯作者：
Sharrief,Anjail
中科院分区：
文献类型：
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作者：
Wysocki,NicoleAnne;Bambhroliya,Arvind;Ankrom,Christy;Vahidy,Farhaan;Astudillo,César;Trevino,Alyssa;Malazarte,Rene;Cossey,TC;Jagolino-Cole,Amanda;Savitz,Sean;Wu,Tzu-Ching;Sharrief,Anjail
背景和目的远程医疗越来越多地用于静脉内tPA（组织型纤溶酶原激活剂）递送。尚未确定将tPA治疗患者留在就诊（分支）医院（滴注和停留）或将患者转移至中心治疗（枢纽）医院（滴注和运送）的比较安全性。我们试图比较通过远程医疗接受tPA治疗的滴注-运输和滴注-停留患者的结局。我们假设，将有没有差异，在短期内的住院死亡率，住院时间，或出院处置或在90天的outcomes between groups.MethodsWe回顾性地确定了tPA治疗的患者在17个发言的医院之间2015年9月和2016年12月。人口统计学、临床和结局数据来自前瞻性远程医疗注册。我们分别使用负二项、多项和逻辑回归分析来评估住院时间、出院处置和住院死亡率。我们比较了90天的修改后的兰金量表评分<2 group.ResultsAmong 430 tPA治疗的患者，232（53.9%）被转移到枢纽治疗后的患者比例。美国国立卫生研究院卒中量表评分的中位数，滴加-运送组（10;四分位数间距，5-18）高于滴加-停留组（6;四分位数间距，4-10;P<0.001）。在滴注和住院患者中，未校正的住院时间较长（发生率比，0.82; 95% CI，0.71-0.95）。在调整后的住院时间、住院死亡率或出院处置方面没有显著差异。在64%的患者完成了90天的改良兰金量表评分，良好的结果（改良兰金量表评分<2）的比例并没有组间差异。ConclusionsWe发现在我们的网络中治疗的drip-and-ship和drip-and-stay患者之间的测量结果没有差异，尽管我们的研究可能是不够有力的检测小的差异。
Background and PurposeTelemedicine is increasingly utilized for intravenous tPA (tissue-type plasminogen activator) delivery. The comparative safety of leaving tPA-treated patients at a presenting (spoke) hospital (drip-and-stay) or transferring patients to a central treating (hub) hospital (drip-and-ship) is not established. We sought to compare outcomes between drip-and-ship and drip-and-stay patients treated with tPA via telemedicine. We hypothesized that there would be no differences in short-term outcomes of in-hospital mortality, length of stay, or discharge disposition or in 90-day outcomes between groups.MethodsWe retrospectively identified patients treated with tPA at 17 spoke hospitals between September 2015 and December 2016. Demographic, clinical, and outcome data were obtained from a prospective telemedicine registry. We used negative binomial, multinomial, and logistic regression analyses to evaluate length of stay, discharge disposition, and inpatient mortality, respectively. We compared the proportion of patients with 90-day modified Rankin Scale score <2 by group.ResultsAmong 430 tPA-treated patients, 232 (53.9%) were transferred to the hub after treatment. The median arrival National Institutes of Health Stroke Scale score was higher for drip-and-ship (10; interquartile range, 5–18) compared with drip-and-stay patients (6; interquartile range, 4–10;P<0.001). Unadjusted length of stay was longer in drip-and-stay patients (incidence rate ratio, 0.82; 95% CI, 0.71–0.95). There were no significant differences in adjusted length of stay, hospital mortality, or discharge disposition. Among the 64% of patients with complete 90-day modified Rankin Scale score, the proportion with good outcomes (modified Rankin Scale score <2) did not differ between groups.ConclusionsWe found no differences in measured outcomes between drip-and-ship and drip-and-stay patients treated in our network, although our study may be underpowered to detect small differences.