National Trends in Telestroke Utilization in a US Commercial Platform Prior to the COVID-19 Pandemic.
National Trends in Telestroke Utilization in a US Commercial Platform Prior to the COVID-19 Pandemic.
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COVID-19 大流行之前美国商业平台远程中风使用的全国趋势。
DOI：
10.1016/j.jstrokecerebrovasdis.2021.106035
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Schwamm LH
中科院分区：
文献类型：
--
作者：
Zachrison KS;Sharma R;Wang Y;Mehrotra A;Schwamm LH
大多数关于电击利用的数据来自单一学术中心辐射式电击网络。我们的目标是描述在 COVID-19 公共卫生紧急事件发生之前，最常用的常见供应商平台之一上的全国远程中风网站样本中远程中风咨询的特征。一家商业远程中风供应商提供了 2013 年至 2019 年两个专业提供商团体的所有远程中风咨询数据。 Kendall 的 τ β 非参数检验用于评估时间趋势。使用广义线性模型来评估医院咨询利用率和根据医院特征调整的阿替普酶使用之间的关联。研究期间，在 132 个轮点进行了 67,736 次远程中风咨询，其中大多数发生在急诊室 (90%) 和中风指征（最终临床诊断：TIA 13%、缺血性中风 39%、出血性中风 2%、类似中风 46%）。中风严重程度较低（中位 NIHSS 2，IQR 0-6）。 23% 的缺血性中风患者被推荐使用阿替普酶。从2013年到2019年，从急诊室到达到NIHSS、CT扫描、影像学检查、会诊和阿替普酶给药的时间均减少（均p<0.05），而从会诊开始到阿替普酶推荐和推注的时间增加（两者均p<0.01）。建议 8% 的缺血性中风患者进行转移。每家医院接受阿替普酶治疗的患者数量随着就诊次数和医院规模的增加而增加，并且在未调整和调整分析中也与美国地区相关。医院参与网络的持续时间越长，阿替普酶输送的医院中位门到针时间越短（每年缩短 39 分钟，p=0.04）。在七年时间范围内使用商业远程中风平台的辐条站点中，咨询开始和阿替普酶推注的时间随着时间的推移而减少。与学术网络类似，参与该商业网络的远程中风的持续时间与更快的阿替普酶递送相关，这表明练习可以提高表现。
Most data on telestroke utilization come from single academic hub-and-spoke telestroke networks. Our objective was to describe characteristics of telestroke consultations among a national sample of telestroke sites on one of the most commonly used common vendor platforms, prior to the COVID-19 public health emergency. A commercial telestroke vendor provided data on all telestroke consultations by two specialist provider groups from 2013-2019. Kendall's τ β nonparametric test was utilized to assess time trends. Generalized linear models were used to assess the association between hospital consult utilization and alteplase use adjusting for hospital characteristics. Among 67,736 telestroke consultations to 132 spoke sites over the study period, most occurred in the emergency department (90%) and for stroke indications (final clinical diagnoses: TIA 13%, ischemic stroke 39%, hemorrhagic stroke 2%, stroke mimics 46%). Stroke severity was low (median NIHSS 2, IQR 0–6). Alteplase was recommended for 23% of ischemic stroke patients. From 2013 to 2019, times from ED arrival to NIHSS, CT scan, imaging review, consult, and alteplase administration all decreased (p<0.05 for all), while times from consult start to alteplase recommendation and bolus increased (p<0.01 for both). Transfer was recommended for 8% of ischemic stroke patients. Number of patients treated with alteplase per hospital increased with increasing number of consults and hospital size and was also associated with US region in unadjusted and adjusted analyses. Longer duration of hospital participation in the network was associated with shorter hospital median door-to-needle time for alteplase delivery (39 min shorter per year, p=0.04). Among spoke sites using a commercial telestroke platform over a seven-year time horizon, times to consult start and alteplase bolus decreased over time. Similar to academic networks, duration of telestroke participation in this commercial network was associated with faster alteplase delivery, suggesting practice improves performance.
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DOI：
10.1016/s1553-7250(06)32025-9
发表时间：
2006-04-01
影响因子：
2.3
作者：
Choi, John Y.;Porche, Nichole A.;Grotta, James C.
通讯作者：
Grotta, James C.
DOI：
10.1161/circoutcomes.119.005903
发表时间：
2020-03-01
影响因子：
6.9
作者：
Sharma, Richa;Zachrison, Kori S.;Schwamm, Lee H.
通讯作者：
Schwamm, Lee H.
影响因子：
8.3
作者：
Schwamm, Lee H.;Audebert, Heinrich J.;White, Christopher J.
通讯作者：
White, Christopher J.
影响因子：
158.5
作者：
Berkhemer, O. A.;Fransen, P. S. S.;Dippel, D. W. J.
通讯作者：
Dippel, D. W. J.
DOI：
10.1056/nejmoa1214300
发表时间：
2013-03-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
Broderick JP;Palesch YY;Demchuk AM;Yeatts SD;Khatri P;Hill MD;Jauch EC;Jovin TG;Yan B;Silver FL;von Kummer R;Molina CA;Demaerschalk BM;Budzik R;Clark WM;Zaidat OO;Malisch TW;Goyal M;Schonewille WJ;Mazighi M;Engelter ST;Anderson C;Spilker J;Carrozzella J;Ryckborst KJ;Janis LS;Martin RH;Foster LD;Tomsick TA;Interventional Management of Stroke (IMS) III Investigators
通讯作者：
Interventional Management of Stroke (IMS) III Investigators