Department of Neurosciences, University of California San Diego School of Medicine, San Diego, CA 92103-8466, USA.
J Stroke Cerebrovasc Dis. 2012 May;21(4):259-64. doi: 10.1016/j.jstrokecerebrovasdis.2010.08.004. Epub 2010 Sep 19.
Telemedicine can provide stroke evaluations in locations with limited available expertise. The reliability of telestroke has been established. Decision making efficacy has been shown in the National Institutes of Health's STRokE DOC trial. No prospective trial has assessed long-term telestroke outcomes, however. In an institutional review board-approved trial (NCT00936455), we contacted patients originally enrolled in the STRokE DOC trial. A telephone script was used to verify consent. Patients were asked standardized questions regarding disposition, modified Rankin Scale (mRS) score, mortality, and recurrent stroke for 2 retrospective time points (6 and 12 months postevent) and one current time point. Blind was maintained. Primary outcome measures of mortality and percent mRS score of 0-1 [%mRS(0-1)] at 6 months are reported. Wilcoxon's rank-sum test was used for continuous variables, and Fisher's exact was used for categorical variables. Of the original 222 participants, 75 patients or surrogates could be contacted. Mean time from enrollment was 3.96 ± 1.0 years (range, 2.33-5.45 years). Mean National Institutes of Health Stroke Scale (NIHSS) score was 8 ± 7 (5 ± 8 for telephone; 12 ± 8 for telemedicine; P = .002). The rate of intravenous recombinant tissue plasminogen activator (rt-PA) use was 31%. Six-month %mRS(0-1) outcome was not different, at 42%. Mortality after imputation to the entire study sample also was not different, at 18%. There was no difference in the rate of recurrent stroke (P = .61). Some 85% of patients were home at 6 months. This study reports a good 6-month outcome for stroke patients evaluated by telemedicine or telephone. This design is limited by the time since original enrollment and resultant inability to contact participants. Although these findings can add to the limited data on telemedicine outcomes, a prospective trial is needed.
远程医疗可以在专业知识有限的地方提供中风评估。远程卒中的可靠性已经得到了证实。美国国立卫生研究院的 STRokE DOC 试验已经证明了决策的效果。然而，还没有前瞻性试验评估长期远程卒中的结果。在一项机构审查委员会批准的试验（NCT00936455）中，我们联系了最初参加 STRokE DOC 试验的患者。使用电话脚本验证同意。患者被问到关于处置、改良 Rankin 量表（mRS）评分、死亡率和复发性中风的标准化问题，时间点为 2 个回顾性时间点（事件后 6 个月和 12 个月）和 1 个当前时间点。保持盲法。报告的主要结果是 6 个月时的死亡率和 mRS 评分 0-1 的百分比（%mRS（0-1））。对于连续变量，使用 Wilcoxon 秩和检验，对于分类变量，使用 Fisher 确切检验。在最初的 222 名参与者中，有 75 名患者或其代理人可以联系。从登记到现在的平均时间为 3.96 ± 1.0 年（范围，2.33-5.45 年）。平均 NIHSS 评分为 8 ± 7（电话为 5 ± 8；远程医疗为 12 ± 8；P =.002）。静脉内重组组织型纤溶酶原激活剂（rt-PA）使用率为 31%。6 个月时%mRS（0-1）的结果没有差异，为 42%。在将整个研究样本推断至缺失数据后，死亡率也没有差异，为 18%。复发性中风的发生率没有差异（P =.61）。大约 85%的患者在 6 个月时在家中。本研究报告了通过远程医疗或电话评估的中风患者的良好 6 个月结果。这种设计受到最初登记时间的限制，导致无法联系到参与者。尽管这些发现可以为远程医疗结果增加有限的数据，但仍需要前瞻性试验。
