远程医疗可在移动卒中单元中替代神经科医生。
Telemedicine Can Replace the Neurologist on a Mobile Stroke Unit.
作者信息
Wu Tzu-Ching, Parker Stephanie A, Jagolino Amanda, Yamal Jose-Miguel, Bowry Ritvij, Thomas Abraham, Yu Amy, Grotta James C
机构信息
From the Department of Neurology (T.-C.W., S.A.P., A.J., R.B.) and Department of Biostatistics, School of Public Health (J.-M.Y.), University of Texas Health Science Center at Houston; Department of Neurology, Houston Methodist Neurological Institute (A.T.); University of Vermont College of Medicine (A.Y.); and Memorial Hermann Hospital (J.C.G.).
出版信息
Stroke. 2017 Feb;48(2):493-496. doi: 10.1161/STROKEAHA.116.015363. Epub 2017 Jan 12.
BACKGROUND AND PURPOSE
The BEST-MSU study (Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit) is a comparative effectiveness trial in patients randomized to mobile stroke unit or standard management. A substudy tested interrater agreement for tissue-type plasminogen activator eligibility between a telemedicine vascular neurologist and onboard vascular neurologist.
METHODS
On scene, both the telemedicine vascular neurologist and onboard vascular neurologist independently evaluated the patient, documenting their tissue-type plasminogen activator treatment decision, National Institutes of Health Stroke Scale score, and computed tomographic interpretation. Agreement was determined using Cohen κ statistic. Telemedicine-related technical failures that impeded remote assessment were recorded.
RESULTS
Simultaneous and independent telemedicine vascular neurologist and onboard vascular neurologist assessment was attempted in 174 patients. In 4 patients (2%), the telemedicine vascular neurologist could not make a decision because of technical problems. The telemedicine vascular neurologist agreed with the onboard vascular neurologist on 88% of evaluations (κ=0.73).
CONCLUSIONS
Remote telemedicine vascular neurologist assessment is reliable and accurate, supporting either telemedicine vascular neurologist or onboard vascular neurologist assessment on our mobile stroke unit.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02190500.
背景与目的
BEST-MSU研究（使用移动卒中单元进行卒中治疗的益处）是一项针对随机分配至移动卒中单元或标准治疗的患者的比较疗效试验。一项子研究测试了远程医疗血管神经科医生与随车血管神经科医生在组织型纤溶酶原激活剂使用资格方面的评分者间一致性。
方法
在现场，远程医疗血管神经科医生和随车血管神经科医生均独立评估患者，记录他们关于组织型纤溶酶原激活剂治疗的决定、美国国立卫生研究院卒中量表评分以及计算机断层扫描解读结果。使用科恩κ统计量确定一致性。记录妨碍远程评估的与远程医疗相关的技术故障。
结果
对174例患者尝试了远程医疗血管神经科医生与随车血管神经科医生同时且独立的评估。在4例患者（2%）中，远程医疗血管神经科医生因技术问题无法做出决定。远程医疗血管神经科医生在88%的评估中与随车血管神经科医生意见一致（κ=0.73）。
结论
远程医疗血管神经科医生评估可靠且准确，支持在我们的移动卒中单元进行远程医疗血管神经科医生评估或随车血管神经科医生评估。
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