Implementation of Telemedicine and Stroke Network in Thrombolytic Administration: Comparison Between Walk-in and Referred Patients
Implementation of Telemedicine and Stroke Network in Thrombolytic Administration: Comparison Between Walk-in and Referred Patients
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DOI：
10.1007/s12028-010-9360-3
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发表时间：
2010-08-01
影响因子：
3.5
通讯作者：
Kommarkg, Urai
中科院分区：
文献类型：
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作者：
Dharmasaroja, Pornpatr A.;Muengtaweepongsa, Sombat;Kommarkg, Urai
本研究的目的是评估远程医疗和Thammasat Stroke Network模型在急性缺血性卒中静脉溶栓治疗中的有效性和安全性。自2007年6月起，远程医疗(电话会诊和远程放射)开始应用于急性缺血性卒中的治疗。Thammasat Stroke Network(TSN)于2008年3月有效地组织起来。法政医院作为“枢纽”医院，在台湾岛有25家“口型”医院。主要观察指标包括3个月时静脉注射组织型纤溶酶原激活剂(TPA)治疗效果良好，与TSN转诊的患者比较有症状性脑出血。实施TSN前后分别有14例(14/170，8%)和110例(110/406，27%)患者接受了tPA治疗。与转诊患者(58例)相比，来医院就诊的患者(66例)从开始到治疗的时间显著缩短(130vs170min，P<；0.0001)。然而，两组患者的良好预后(48%比42%，P=0.538)和症状性脑出血发生率(3%比2%，P=0.637)没有显著差异。远程医疗和TSN的实施显著增加了tPA的给药，而不影响有利和安全的结果。
The purpose of this study was to evaluate the efficacy and safety of implementation of telemedicine and the Thammasat Stroke Network model in treating acute ischemic stroke patients with intravenous thrombolysis.Telemedicine (telephone consultation and tele-radiology) has been used in acute ischemic stroke management since June, 2007. The Thammasat Stroke Network (TSN) was effectively organized in March, 2008. Thammasat Hospital served as a "hub" hospital, with 25 "spoke" hospitals in the TSN. The main outcome measures included favorable outcome of the patients treated with intravenous tissue plasminogen activator (tPA) at 3 months and symptomatic intracerebral hemorrhage by comparison between walk-in patients and the patients who were referred by the TSN.There were 14 patients (14 out of 170 acute ischemic stroke patients, 8%) and 110 patients (110 out of 406 patients, 27%) receiving tPA, before and after implementation of TSN, respectively. Walk-in patients (66 patients) had significant shorter onset-to-treatment duration as compared with referred patients (58 patients) (130 vs. 170 min, P < 0.0001). However, there was no significant difference in favorable outcome (48 vs. 42%, P = 0.538) and rate of symptomatic intracerebral hemorrhage (3 vs. 2%, P = 0.637).Implementation of telemedicine and TSN markedly increased tPA administrations, without compromising favorable and safety outcomes.