Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Can J Cardiol. 2018 Jul;34(7):889-896. doi: 10.1016/j.cjca.2017.12.025. Epub 2017 Dec 27.
Stroke is a leading cause of adult disability and the fourth leading cause of death in Canada. Most strokes are ischemic and functional outcome is highly time-dependent, making fast diagnosis and treatment initiation crucial. This poses a challenge in vast geographical areas where stroke neurology expertise is only available in urban centres. In this article we review the rationale for telestroke networks and their current implementation in Canada. Telestroke networks enable stroke-specific procedures to be performed by less experienced physicians under the guidance of stroke neurology experts. We also present evidence that the safety and effectiveness of intravenous alteplase in community hospitals in a telestroke network seems to be comparable with that achieved in dedicated stroke centres. It is thus a viable option to guarantee an aging population access to stroke care across large geographic regions with faster treatment and access to more advanced treatment options by means of transfer to a comprehensive centre if necessary. Although telestroke networks have an upfront implementation cost, they can lead to reduced direct and indirect costs for the health care system by reducing days spent in the hospital as well as disability with the need for long-term care. Telestroke networks can also be used for identification and enrollment of patients into emergency stroke trials and thus provide a more representative sample of the population and increase recruitment. Standardization of regional telestroke networks could lead to collaborations with larger data acquisitions for research purposes and quality control in the future.
脑卒中是加拿大成年人残疾的主要原因，也是导致死亡的第四大原因。大多数脑卒中是缺血性的，其功能结果高度依赖时间，因此快速诊断和及时开始治疗至关重要。在地域辽阔的地区，由于只有城市中心才有脑卒中神经科专家，这就带来了挑战。本文综述了远程脑卒中网络的基本原理及其在加拿大的当前应用。远程脑卒中网络使得经验较少的医生在脑卒中神经科专家的指导下能够进行专门针对脑卒中的操作。我们还提供了证据表明，在远程脑卒中网络中的社区医院中使用静脉注射阿替普酶进行治疗的安全性和有效性与在专门的脑卒中中心中相当。因此，对于人口老龄化的地区来说，通过远程脑卒中网络，在保证更快的治疗速度的同时，如果需要还可以将患者转移到综合中心，以获得更先进的治疗选择，这是一种可行的方案，可以确保在地域广大的地区中为脑卒中患者提供治疗。虽然远程脑卒中网络的实施需要前期投入，但它们可以通过减少住院天数以及减少需要长期护理的残疾人数，从而降低医疗保健系统的直接和间接成本。远程脑卒中网络还可用于识别和招募参与紧急脑卒中试验的患者，从而为研究提供更具代表性的人群样本并增加招募人数。未来，远程脑卒中网络的标准化可以促进与更大规模的数据采集合作，以用于研究和质量控制。
