Department of Neurology, Mayo Clinic, Phoenix, Arizona 85054, USA.
Telemed J E Health. 2012 Apr;18(3):230-7. doi: 10.1089/tmj.2011.0116. Epub 2012 Mar 8.
Telemedicine can disseminate vascular neurology expertise and optimize recombinant tissue plasminogen activator (rt-PA) use for acute ischemic stroke in rural underserved communities. The purpose of this study was to prospectively assess whether telemedicine or telephone was superior for decision-making.
The study design is a pooled analysis of two identically designed randomized controlled trials conducted in a multistate hub and spoke telestroke network setting with acute stroke syndrome patients, comparing telemedicine versus telephone-only consultations. From each trial, common data elements were pooled to assess, principally, for correctness of thrombolysis decision-making. Secondary outcomes included rt-PA use rate, 90-day functional outcome, post-thrombolysis intracranial hemorrhage, and data completeness.
Two hundred seventy-six pooled patients were evaluated. Correct thrombolysis eligibility decisions were made more often with telemedicine (96% telemedicine, 83% telephone; odds ratio [OR] 4.2; 95% confidence interval [CI] 1.69-10.46; p=0.002). Intravenous rt-PA usage was 26% (29% telemedicine, 24% telephone; OR 1.27; 95% CI 0.71-2.25; p=0.41). Ninety-day outcomes were not different for Barthel Index, modified Rankin Scale, or mortality. There was no difference in post-thrombolysis intracranial hemorrhage (8% telemedicine, 6% telephone; p>0.999).
This pooled analysis supports the hypothesis that stroke telemedicine consultations, compared with telephone-only, result in more accurate decision-making. Together with high rt-PA utilization rate, low post-rt-PA intracranial hemorrhage rate, and acceptable patient outcome, the results confirm that telemedicine is a viable consultative tool for acute stroke. The replication of the hub and spoke network infrastructure supports the generalizability of telemedicine when used in broader settings.
远程医疗可以传播血管神经科专业知识，并优化重组组织型纤溶酶原激活剂（rt-PA）在农村服务不足社区的急性缺血性脑卒中的使用。本研究的目的是前瞻性评估远程医疗或电话在决策方面的优势。
该研究设计是对在多州中枢-外围远程卒中网络环境中进行的两项完全相同的随机对照试验的汇总分析，急性脑卒中综合征患者比较了远程医疗与仅电话咨询。从每个试验中，汇总了常见的数据元素，主要评估溶栓决策的正确性。次要结局包括 rt-PA 的使用率、90 天功能结局、溶栓后颅内出血和数据完整性。
共评估了 276 例汇总患者。远程医疗更频繁地做出正确的溶栓资格决策（96%远程医疗，83%电话；优势比[OR]4.2；95%置信区间[CI]1.69-10.46；p=0.002）。静脉内 rt-PA 的使用率为 26%（29%远程医疗，24%电话；OR 1.27；95%CI0.71-2.25；p=0.41）。90 天结局在巴氏指数、改良 Rankin 量表或死亡率方面没有差异。溶栓后颅内出血无差异（8%远程医疗，6%电话；p>0.999）。
这项汇总分析支持这样的假设，即与仅电话咨询相比，卒中远程医疗咨询可做出更准确的决策。加上高 rt-PA 使用率、低 rt-PA 后颅内出血率和可接受的患者结局，结果证实远程医疗是急性脑卒中的一种可行的咨询工具。中枢-外围网络基础设施的复制支持了远程医疗在更广泛的环境中使用的普遍性。
