Use of telemedicine and helicopter transport to improve stroke care in remote locations.
Use of telemedicine and helicopter transport to improve stroke care in remote locations.
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DOI：
10.1007/s11936-011-0124-y
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发表时间：
2011-06
影响因子：
--
通讯作者：
Hess, David C
中科院分区：
文献类型：
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作者：
Saler, Mihaela;Switzer, Jeffrey A;Hess, David C
静脉注射重组组织纤溶酶原激活剂是美国食品和药物管理局唯一批准用于治疗急性中风的药物。尽管疗效已得到证实，但只有不到 3% 的中风患者接受治疗，对于居住在偏远地区的患者来说，这一数字甚至更小。部分原因是这些农村社区缺乏神经科医生和中风专家。传统的“运送和滴灌”模式浪费了关键时间，导致治疗延误或损失。在这篇综述中，我们讨论了克服中风护理地理差异和改善偏远地区急性治疗的策略。从现场到中风中心的直升机运输是将患者快速运送到中风中心的一种选择。然而，地理、天气和不必要的交通都是潜在的缺点。另外，“远程中风”有助于通过视听链接和计算机断层扫描图像的传输对急性中风患者进行远程评估。尽管物理上分离，中风专家仍能够检查患者、检查脑成像并做出正确的治疗决策；然后可以酌情转移到中风中心。尽管最近远程中风网络的激增表明对某些医院系统来说是一种经济资产，但仍需要对远程中风进行成本效益分析。
Intravenous recombinant tissue plasminogen activator is the only medication approved by the US Food and Drug Administration for treatment of acute stoke. Despite established efficacy, less than 3% of stroke patients receive treatment, and that number is even smaller for patients living in remote locations. This is in part due to a lack of neurologists and stroke specialists in these rural communities. The traditional model of “ship and drip” wastes crucial time, resulting in delays or loss of treatment. In this review, we discuss strategies to overcome geographic disparities in stroke care and improve acute treatment in remote locations. Helicopter transport from field to stroke center is one option to rapidly deliver patients to stroke centers. However, geography, weather, and unnecessary transport are potential drawbacks. Alternatively, “telestroke” facilitates remote evaluation of acute stroke patients via an audiovisual link and transmission of computerized tomography images. Despite the physical separation, stroke specialists are able to examine patients, review brain imaging and make correct treatment decisions; transfer to a stroke center can then be performed as appropriate. A cost-benefit analysis of telestroke is needed, although the recent proliferation of telestroke networks suggests an economic asset to some hospital systems.