Department of Neurology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
Stroke. 2012 Nov;43(11):3095-7. doi: 10.1161/STROKEAHA.112.666255. Epub 2012 Sep 13.
The American Stroke Association guidelines emphasized the need for further high-quality studies that assess agreement by radiologists and nonradiologists engaged in emergency telestroke assessments and decision-making. Therefore, the objective of this study was to determine the level of agreement of baseline brain CT scan interpretations of patients with acute stroke presenting to telestroke spoke hospitals between central reading committee neuroradiologists and each of 2 groups, spoke hospital radiologists and hub hospital vascular neurologists (telestrokologists).
The Stroke Team Remote Evaluation Using a Digital Observation Camera Arizona trial was a prospective, urban single-hub, rural 2-spoke, randomized, blinded, controlled trial of a 2-way, site-independent, audiovisual telemedicine and teleradiology system designed for remote evaluation of adult patients with acute stroke versus telephone consultation to assess eligibility for treatment with intravenous thrombolysis. In the telemedicine arm, the subjects' CT scans were interpreted by the hub telestrokologist and in the telephone arm by the spoke radiologist. All subjects' CT scans were subsequently interpreted centrally, independently, and blindly by 2 hub neuroradiologists. The primary CT outcome was determination of a CT-based contraindication to thrombolytic treatment. Kappa statistics and exact agreement rates were used to analyze interobserver agreement.
Fifty-four subjects underwent random assignment. The overall agreement for the presence of radiological contraindications to thrombolysis was excellent (0.91) and did not differ substantially between the hub telestrokologist to neuroradiologist and spoke radiologist to neuroradiologist (0.92 and 0.89, respectively).
In the context of a telestroke network designed to assess patients with acute stroke syndromes, agreement over the presence or absence of radiological contraindications to thrombolysis was excellent whether the comparisons were between a telestrokologist and neuroradiologist or between spoke radiologist and neuroradiologist.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00623350.
美国卒中协会指南强调需要进一步开展高质量研究，评估参与远程卒中评估和决策的放射科医生和非放射科医生之间的一致性。因此，本研究的目的是确定远程卒中接诊医院的核心阅读委员会神经放射科医生与 2 个组（接诊医院放射科医生和卒中中心血管神经科医生[远程卒中医生]）之间对急性卒中患者的基线脑部 CT 扫描解读的一致性水平。
“使用数字观察摄像机进行远程评估的卒中团队试验（Stroke Team Remote Evaluation Using a Digital Observation Camera Arizona trial）”是一项前瞻性城市单中心、农村 2 分中心、随机、盲法、对照试验，旨在评估一种用于远程评估急性卒中成人患者的 2 种方法、站点独立、视听远程医疗和远程放射学系统，与电话咨询相比，该系统可评估患者接受静脉溶栓治疗的资格。在远程医疗组中，由卒中中心远程卒中医生对患者的 CT 扫描进行解读，而在电话组中由接诊医院放射科医生进行解读。所有患者的 CT 扫描随后由 2 名卒中中心神经放射科医生进行中心、独立和盲法解读。主要 CT 结局是确定基于 CT 的溶栓治疗禁忌证。kappa 统计量和确切一致率用于分析观察者间一致性。
54 名患者接受了随机分配。溶栓治疗的放射学禁忌证存在的总体一致性非常好（0.91），并且在卒中中心远程卒中医生与神经放射科医生以及接诊医院放射科医生与神经放射科医生之间没有明显差异（分别为 0.92 和 0.89）。
在专为评估急性卒中介导综合征患者而设计的远程卒中网络中，无论比较的是远程卒中医生与神经放射科医生之间，还是接诊医院放射科医生与神经放射科医生之间，对于溶栓治疗的放射学禁忌证的存在或不存在，其一致性都非常好。
