From the McGovern Medical School at the University of Texas Health Science Center at Houston.
Stroke. 2017 Sep;48(9):2618-2620. doi: 10.1161/STROKEAHA.117.017394. Epub 2017 Jul 28.
Formal telestroke training for neurovascular fellows (NVFs) is necessary because of growing use of telestroke technologies in the management of acute ischemic stroke; yet, educational approaches and training benchmarks are not formalized. Time between telestroke consultant page and tissue-type plasminogen activator administration (page-to-needle time, PTNT) can provide an objective measure of proficiency. We compared PTNT between NVFs and neurovascular attendings (NVAs) and evaluated changes in PTNT with experience.
We identified suspected acute ischemic stroke patients in our telestroke registry from July 2013 to December 2015 who received tissue-type plasminogen activator. Using multivariable quantile regression, we estimated the difference and 95% confidence interval in median PTNT between NVFs and NVAs. We also report the coefficient of change in PTNT over increasing number of telestroke consults.
NVFs evaluated 53.7% of 618 tissue-type plasminogen activator cases over telestroke. NVAs had significantly shorter PTNT compared with NVFs, with a difference in median PTNT of -9 minutes (95% confidence interval, -12.3 to -5.7). This difference persisted when adjusted for relative tissue-type plasminogen activator contraindications. For each additional telestroke consult, PTNT decreased by 0.07 minutes for NVFs or NVAs (=0.02 and <0.01, respectively).
PTNT improves by ≈1 minute for every 14 consults for both NVFs and NVAs. Our findings support the importance of integrating telestroke training into supervised neurovascular fellowships to increase proficiency prior to independent practice and suggest that PTNT can be a benchmark for tracking proficiency.
由于远程卒中技术在急性缺血性卒中治疗中的应用日益广泛，神经血管研究员（NVFs）需要接受正式的远程卒中培训；然而，目前还没有规范化的教育方法和培训基准。远程卒中顾问响应时间（page-to-needle time，PTNT）可作为熟练程度的客观衡量标准。本研究比较了 NVFs 和神经血管主治医生（NVAs）之间的 PTNT，并评估了经验积累对 PTNT 的影响。
我们从 2013 年 7 月至 2015 年 12 月的远程卒中注册系统中确定了接受组织型纤溶酶原激活剂治疗的疑似急性缺血性卒中患者。采用多元分位数回归方法，我们估计了 NVFs 和 NVAs 之间的中位 PTNT 差异及其 95%置信区间。我们还报告了 PTNT 随远程卒中咨询数量增加而变化的系数。
在 618 例接受组织型纤溶酶原激活剂治疗的患者中，NVFs 评估了 53.7%的患者。与 NVAs 相比，NVFs 的 PTNT 显著延长，中位数差异为 -9 分钟（95%置信区间，-12.3 至 -5.7）。在调整相对组织型纤溶酶原激活剂禁忌证后，这种差异仍然存在。对于每增加一次远程卒中咨询，NVFs 和 NVAs 的 PTNT 分别减少 0.07 分钟（分别为 0.02 和 <0.01）。
对于 NVFs 和 NVAs 而言，每增加 14 次咨询，PTNT 可提高约 1 分钟。我们的研究结果支持将远程卒中培训纳入监督神经血管研究员培训的重要性，以提高其在独立实践前的熟练程度，并表明 PTNT 可以作为跟踪熟练程度的基准。
