Department of Ageing & Health, Guy's and St Thomas' Hospitals, St Thomas' Hospital, London SE1 7EH, UK.
Postgrad Med J. 2012 Mar;88(1037):134-7. doi: 10.1136/postgradmedj-2011-130060. Epub 2012 Jan 19.
Telemedicine is increasingly used in the UK to deliver thrombolysis. It is primarily used to enable assessment of people presenting with an acute stroke by a remote specialist in stroke care, and to determine eligibility for thrombolysis with alteplase (recombinant tissue plasminogen activator). This study aims to evaluate the process of acute stroke care, safety and outcome profiles when comparing face-to-face evaluation and telemedicine in the delivery of thrombolysis.
This was a retrospective single centre cohort study, evaluating patients thrombolysed from July 2007 to December 2009 inclusive. All patients were given treatment within a 3-hour window from onset of symptoms. Of the 97 patients thrombolysed, 45 (46%) were evaluated by telemedicine. Process times of the steps taken to deliver thrombolysis for the two groups were compared. The authors include the rates of symptomatic intracranial haemorrhage (SICH). Outcome data include 3-month mortality and functional status.
Process times were significantly better in face-to-face: Admission to CT (p=0.001), CT to treatment (p≤0.001) and admission to treatment (p≤0.001). SICH occurred in four patients (7.7%) in the face-to-face group compared with the two patients (4.4%) in the telemedicine group (p=0.7). Favourable outcome: a modified Rankin score of 0-2 was observed in 19 patients (36.5%) in the face-to-face group compared with 19 patients (42%) in the telemedicine group (p=0.9).
This analysis shows that the use of telemedicine compared with face-to-face evaluation is feasible in the delivery of thrombolysis during out of hours. There are several areas of our emergency process of hyper-acute stroke care that need improving when using telemedicine.
远程医疗在英国越来越多地用于提供溶栓治疗。它主要用于通过远程卒中护理专家评估出现急性卒中的患者，并确定是否有资格使用阿替普酶（重组组织纤溶酶原激活剂）进行溶栓。本研究旨在评估在提供溶栓治疗时，面对面评估与远程医疗比较时的急性卒中护理过程、安全性和结果概况。
这是一项回顾性单中心队列研究，评估了 2007 年 7 月至 2009 年 12 月期间接受溶栓治疗的患者。所有患者均在症状发作后 3 小时内接受治疗。在接受溶栓治疗的 97 例患者中，有 45 例（46%）通过远程医疗进行了评估。比较了两组溶栓治疗的各个步骤的处理时间。作者还包括症状性颅内出血（SICH）的发生率。结局数据包括 3 个月死亡率和功能状态。
面对面组的处理时间明显更短：CT 检查入院（p=0.001）、CT 检查至治疗（p≤0.001）和入院至治疗（p≤0.001）。面对面组有 4 例（7.7%）患者发生 SICH，而远程医疗组有 2 例（4.4%）（p=0.7）。良好结局：面对面组 19 例（36.5%）患者改良 Rankin 评分为 0-2，远程医疗组 19 例（42%）（p=0.9）。
本分析表明，与面对面评估相比，在非工作时间提供溶栓治疗时，使用远程医疗是可行的。在使用远程医疗时，我们的超急性卒中护理急诊流程有几个方面需要改进。
