Feasibility of Prehospital Teleconsultation in Acute Stroke - A Pilot Study in Clinical Routine
Feasibility of Prehospital Teleconsultation in Acute Stroke - A Pilot Study in Clinical Routine
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DOI：
10.1371/journal.pone.0036796
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发表时间：
2012-05-18
期刊：
影响因子：
3.7
通讯作者：
Skorning, Max
中科院分区：
文献类型：
--
作者：
Bergrath, Sebastian;Reich, Arno;Skorning, Max
背景：医院间远程会诊改善了中风的护理。为了将这一概念转化到紧急医疗服务(EMS)中，对院前远程会诊的可行性和效果进行了调查。方法/主要发现：在救护车和远程会诊中心之间进行了远程会诊，实现了音频通信、实时视频流、生命数据和静止图像传输。医院的预先通知是通过电子邮件到传真的14项中风病史核对表进行的。除了技术评估外，通过比较远程医疗辅助院前护理(远程医疗组)和当地常规EMS护理(对照组)，研究了可能对院前和初始住院时间间隔、院前诊断准确性和卒中特定数据传输的影响。所有住院前5个月的中风患者都在工作日(上午7：30)。-下午4时)。在18个特派团中，有3个发生了系统的部分缺失；12个病例通过视频传输进行了神经学联合评估。14例(78%)传递了卒中检查表。远程医疗组(n=18)与对照组(n=47)：院前时间间隔相似，但两组进入脑成像的时间都比推荐的时间长(中位数59.5vs.57.5min，p=0.6447)。院前中风的确诊率分别为61%和67%，p=0.8451。14个(IQR 9)和5个(IQR 2)卒中特定项目的中位数以书面形式转移到住院环境，P<；0.0001。10例患者中3例使用溶栓剂，27例患者中5例使用溶栓剂，P=0.655。结论：远程会诊是可行的，但技术性能和可靠性有待提高。这种方法导致了更好的卒中特定信息；然而，没有发现比常规EMS护理更好的优势，两组住院时间间隔都长得令人无法接受。院前远程中风咨询的可行性未来有可能改善急救护理，特别是在没有训练有素的人员在场的情况下。
Background: Inter-hospital teleconsultation improves stroke care. To transfer this concept into the emergency medical service (EMS), the feasibility and effects of prehospital teleconsultation were investigated.Methodology/Principal Findings: Teleconsultation enabling audio communication, real-time video streaming, vital data and still picture transmission was conducted between an ambulance and a teleconsultation center. Pre-notification of the hospital was carried out with a 14-item stroke history checklist via e-mail-to-fax. Beside technical assessments possible influences on prehospital and initial in-hospital time intervals, prehospital diagnostic accuracy and the transfer of stroke specific data were investigated by comparing telemedically assisted prehospital care (telemedicine group) with local regular EMS care (control group). All prehospital stroke patients over a 5-month period were included during weekdays (7.30 a.m. - 4.00 p.m.). In 3 of 18 missions partial dropouts of the system occurred; neurological co-evaluation via video transmission was conducted in 12 cases. The stroke checklist was transmitted in 14 cases (78%). Telemedicine group (n = 18) vs. control group (n = 47): Prehospital time intervals were comparable, but in both groups the door to brain imaging times were longer than recommended (median 59.5 vs. 57.5 min, p = 0.6447). The prehospital stroke diagnosis was confirmed in 61% vs. 67%, p = 0.8451. Medians of 14 (IQR 9) vs. 5 (IQR 2) stroke specific items were transferred in written form to the in-hospital setting, p < 0.0001. In 3 of 10 vs. 5 of 27 patients with cerebral ischemia thrombolytics were administered, p = 0.655.Conclusions: Teleconsultation was feasible but technical performance and reliability have to be improved. The approach led to better stroke specific information; however, a superiority over regular EMS care was not found and in-hospital time intervals were unacceptably long in both groups. The feasibility of prehospital tele-stroke consultation has future potential to improve emergency care especially when no highly trained personnel are on-scene.