Schwab S, Vatankhah B, Kukla C, Hauchwitz M, Bogdahn U, Fürst A, Audebert H J, Horn M
Department of Neurology, University of Regensburg, Regensburg, Germany.
Neurology. 2007 Aug 28;69(9):898-903. doi: 10.1212/01.wnl.0000269671.08423.14.
IV thrombolysis represents the most effective acute stroke therapy. However, it is almost exclusively performed in stroke centers and is not available in most community areas. The Telemedical Pilot Project for Integrative Stroke Care (TEMPiS) was started in February 2003. Twelve community hospitals with no or very limited stroke thrombolysis experience and two stroke centers were connected via a network providing online neurologic examination and transfer of neuroradiologic scans. Following recently published preliminary results on acute phase safety of telethrombolysis, the present study reports on its long-term functional outcome.
Modified Rankin Scale (mRS), Barthel Index (BI), and mortality rate were prospectively collected 3 and 6 months after IV thrombolysis in patients of community network hospitals (telemedical group) and the stroke centers. Values of 95/100 for the BI and 0/1 for the mRS were defined as a favorable outcome.
Over the first 22 months, 170 patients were treated with tPA in the telemedical hospitals and 132 in the stroke center hospitals. Mortality rates were 11.2% vs 11.5% at 3 months (p = 0.55) and 14.2% vs 13% at 6 months (p = 0.45). A good functional outcome after 6 months was found in 39.5% of the telemedical hospitals vs 30.9% of the stroke centers (p = 0.10) for the mRS and 47.1% vs 44.8% (p = 0.44) regarding the BI.
Mortality rates and functional outcomes for telemedicine-linked community hospitals and stroke centers were similar and comparable to the results from randomized trials.
静脉溶栓是急性脑卒中最有效的治疗方法。然而，它几乎只在卒中中心进行，大多数社区地区无法开展。整合性卒中治疗远程医疗试点项目（TEMPiS）于2003年2月启动。12家没有或仅有非常有限的卒中溶栓经验的社区医院和2家卒中中心通过一个提供在线神经学检查和神经放射学扫描传输的网络连接起来。继最近发表的关于远程溶栓急性期安全性的初步结果之后，本研究报告其长期功能结局。
前瞻性收集社区网络医院（远程医疗组）和卒中中心患者静脉溶栓后3个月和6个月时的改良Rankin量表（mRS）、Barthel指数（BI）及死亡率。BI值95/100和mRS值0/1被定义为良好结局。
在最初的22个月里，远程医疗医院有170例患者接受了组织型纤溶酶原激活剂（tPA）治疗，卒中中心医院有132例。3个月时死亡率分别为11.2%和11.5%（p = 0.55），6个月时分别为14.2%和13%（p = 0.45）。6个月后，远程医疗医院mRS良好功能结局的比例为39.5%，卒中中心为30.9%（p = 0.10）；BI方面，远程医疗医院为47.1%，卒中中心为44.8%（p = 0.44）。
远程医疗连接的社区医院和卒中中心的死亡率及功能结局相似，与随机试验结果相当。
