基于急性缺血性脑卒中患者头部CT扫描的影像学解读报告进行静脉溶栓的资格判定。

Eligibility determination for intravenous thrombolysis based on radiology interpretation report of the head CT scan in patients with acute ischemic stroke.

作者信息

Hassan Ameer E, Majidi Shahram, Janjua Nazli A, Chaudhry Saqib A, Tekle Wondwossen G, Grigoryan Mikayel, Qureshi Adnan I

机构信息

Valley Baptist Brain & Spine Network, Harlingen, TX.

出版信息

J Neuroimaging. 2014 Jul-Aug;24(4):349-53. doi: 10.1111/jon.12045. Epub 2013 Sep 9.

DOI:10.1111/jon.12045

PMID:24015702

Abstract

OBJECTIVE

To evaluate the variability of determining eligibility for intravenous thrombolysis (IV t-PA) by a stroke team interpretation of computed tomographic (CT) scan of the head versus review of the radiology interpretation (presented in final report) in patients with acute ischemic stroke.

METHODS

We compiled a database of all IV t-PA-treated ischemic stroke patients at our academic institution based on the stroke team's CT scan interpretation. The CT scan reports of 171 patients were reviewed by an independent board-certified vascular neurologist who was blinded to clinical information except that all patients were being considered for IV t-PA to determine their eligibility for thrombolysis. The reviewer's responses were then compared with the treating team's decision to identify discrepancies, and the impact of the discrepant decisions on clinical outcome including 24-hour National Institute of Health stroke Scale (NIHSS) score and discharge modified Rankin scale (mRS), symptomatic hemorrhage (sICH), and asymptomatic hemorrhage (aICH). We compared the outcomes of patients who received IV t-PA despite cautionary neuroradiologist interpretation and placebo-treated patients from NINDS t-PA study.

RESULTS

The independent reviewer decided to treat with IV t-PA 123 patients (72%) after reviewing the radiology reports. The rate of NIHSS score improvement (52.0% vs. 62.5%, P = .22) was not different between patients in whom IV t-PA should or should not have been used based on radiology reports. Favorable clinical outcome defined by mRS of 0-2 at discharge (50.4% vs. 47.9%, P = .77) and in-hospital mortality (15.6% vs. 12.5%, P = .61) were similar between the 2 groups. Favorable outcome (discharge or day 7-10 mRS 0-2) was significantly higher in patients who received t-PA compared with placebo-treated patients (48% vs. 28%, P = .006).

CONCLUSION

Our study demonstrates that administering IV t-PA to patients based on the stroke team's interpretation of the CT scan versus review of the radiology interpretation does not lead to significant differences in clinical outcome, aICH, or sICH.

摘要

目的

评估由卒中团队解读头部计算机断层扫描（CT）与审查放射学解读（最终报告中呈现）来判定急性缺血性卒中患者静脉溶栓（IV t-PA） eligibility的变异性。

方法

我们根据卒中团队对CT扫描的解读，汇编了我们学术机构所有接受IV t-PA治疗的缺血性卒中患者的数据库。171例患者的CT扫描报告由一名独立的、具有血管神经病学专业认证的医生进行审查，该医生对临床信息不知情，但知晓所有患者均在考虑接受IV t-PA以确定其溶栓eligibility。然后将审查者的回复与治疗团队的决定进行比较以识别差异，以及差异决定对临床结局的影响，包括24小时美国国立卫生研究院卒中量表（NIHSS）评分和出院时改良Rankin量表（mRS）、症状性出血（sICH）和无症状性出血（aICH）。我们比较了尽管有神经放射科医生的警示性解读仍接受IV t-PA治疗的患者与美国国立神经疾病与卒中研究所（NINDS）t-PA研究中接受安慰剂治疗的患者的结局。

结果

独立审查者在审查放射学报告后决定对123例患者（72%）进行IV t-PA治疗。根据放射学报告，IV t-PA应该或不应该使用的患者之间，NIHSS评分改善率（52.0%对62.5%，P = 0.22）没有差异。两组之间出院时mRS为0 - 2所定义的良好临床结局（50.4%对47.9%，P = 0.77）和住院死亡率（15.6%对12.5%，P = 0.61）相似。与接受安慰剂治疗的患者相比，接受t-PA治疗的患者中良好结局（出院或第7 - 10天mRS为0 - 2）显著更高（48%对28%，P = 0.006）。