The impact of tele-neurologists on acute stroke care at an advanced primary stroke centre
The impact of tele-neurologists on acute stroke care at an advanced primary stroke centre
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DOI：
10.1177/1357633x20921039
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发表时间：
2020-05-14
影响因子：
4.7
通讯作者：
Stillinger, Toni
中科院分区：
文献类型：
--
作者：
Gutovitz, Scott;Leggett, Jonathan;Stillinger, Toni
我们在一家先进的卒中中心评估了远程神经科医生与传统的床边神经科医生在启动急性卒中护理的时间方面的影响。方法：这项观察性研究评估了单一医院的急性卒中患者的治疗时间，该医院被认证为具有血栓清除能力的先进的初级卒中中心。将2016年3月1日至2018年3月31日连续就诊的卒中预警患者根据其神经内科会诊服务分为两组(床边神经科：2016年3月1日-2017年2月28日；远程神经科：2017年4月1日-2018年3月31日)。结果959例卒中患者符合纳入标准(436例床边神经科患者，523例远程神经科患者)。在性别、年龄或中风最终诊断方面，两组之间没有显著差异(p>；0.05)。85例床边神经内科患者接受tPA治疗，35例接受机械取栓治疗，84例接受远程神经科治疗，44例接受远程神经内科治疗。远程神经科患者上门就诊时间(中位数)分钟(51.5~83.5min)显著高于床边神经科患者(45min，34~69分钟；p<；0.0001)。在床边神经科(87.2+/-33.3分钟)和远程神经科(90.4+/-33.4分钟；p=0.67)之间，到达门到IR的时间(平均+/-SD)没有差异。讨论在这个机构，我们的远程神经科服务供应商与床边神经科医生相比，tPA给药的统计显著延迟有关。从门到IR的时间没有差别。TPA给药的延迟使其更难达到急性卒中护理指南，并可能恶化患者的预后。
IntroductionWe evaluated the impact of tele-neurologists on the time to initiating acute stroke care versus traditional bedside neurologists at an advanced stroke center.MethodsThis observational study evaluated time to treatment for acute stroke patients at a single hospital, certified as an advanced primary stroke centre, with thrombectomy capabilities. Consecutive stroke alert patients between 1 March, 2016 and 31 March, 2018 were divided into two groups based on their neurology consultation service (bedside neurology: 1 March, 2016-28 February, 2017; tele-neurology: 1 April, 2017-31 March, 2018). Door-to-tPA time and door-to-IR time for mechanical thrombectomy were compared between the two groups.ResultsNine hundred and fifty-nine stroke patients met the inclusion criteria (436 bedside neurology, 523 tele-neurology patients). There were no significant differences in sex, age, or stroke final diagnosis between groups (p > 0.05). 85 bedside neurology patients received tPA and 35 had mechanical thrombectomy, 84 and 44 for the tele-neurology group respectively. Door-to-tPA time (median (IQR)) was significantly higher among tele-neurology (64 min (51.5-83.5)) than bedside neurology patients (45 min (34-69); p < 0.0001). There was no difference in door-to-IR times (mean +/- SD) between bedside neurology (87.2 +/- 33.3 min) and tele-neurology (90.4 +/- 33.4 min; p = 0.67).DiscussionAt this facility, our tele-neurology services vendor was associated with a statistically significant delay in tPA administration compared with bedside neurologists. There was no difference in door-to-IR times. Delays in tPA administration make it harder to meet acute stroke care guidelines and could worsen patient outcomes.