From the Department of Neurology, McGovern Medical School (R.B., S.A.P., J.-M.Y., N.R.-G., T.-C.W.).
School of Public Heath, Department of Biostatistics (J.-M.Y., H.H., S.A.).
Stroke. 2018 Jun;49(6):1528-1530. doi: 10.1161/STROKEAHA.117.020585. Epub 2018 May 2.
Mobile stroke units (MSUs) can speed treatment with intravenous tPA (tissue-type plasminogen activator). We previously showed substantial agreement between a telemedicine-based vascular neurologist (TM-VN) and an onboard vascular neurologist (OB-VN) for the evaluation of patients with stroke for tPA eligibility on an MSU. However, the time efficiency of the telemedicine-based evaluation remained uncertain. In this study, we examined the speed of decision and treatment from MSU arrival for the TM-VN compared with an OB-VN.
In 50 consecutive situations, the TM-VN served as the primary decision maker. Times from MSU arrival to tPA decision and tPA bolus were compared with the same metrics for when the OB-VN served as the primary decision maker.
Time to tPA decision for the TM-VN was 21 minutes (interquartile range, 16.25-26) versus 18 minutes (interquartile range, 14-22) for the OB-VN (=0.01). Initiation of tPA bolus was 24 minutes (interquartile range, 19.75-30) for the TM-VN versus 24 minutes (interquartile range, 19-27.75) for the OB-VN (=0.5).
Assessment by a TM-VN is comparable with an OB-VN in making decisions about tPA administration on an MSU and does not lead to treatment delays.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT02190500.
移动卒中单元 (MSU) 可加快静脉注射 tPA（组织型纤溶酶原激活物）的治疗速度。我们之前曾展示过，远程医疗为基础的血管神经科医生（TM-VN）和随车血管神经科医生（OB-VN）在对 MSU 上的卒中患者进行 tPA 适用性评估方面有很大的一致性。然而，远程医疗评估的时间效率仍然不确定。在这项研究中，我们检查了 TM-VN 与 OB-VN 相比，从 MSU 到达到 tPA 决策和 tPA 推注的决策速度和治疗速度。
在 50 个连续的情况下，TM-VN 作为主要决策者。将从 MSU 到达到 tPA 决策和 tPA 推注的时间与 OB-VN 作为主要决策者的相同指标进行比较。
TM-VN 进行 tPA 决策的时间为 21 分钟（四分位距，16.25-26），而 OB-VN 为 18 分钟（四分位距，14-22）（=0.01）。TM-VN 开始 tPA 推注的时间为 24 分钟（四分位距，19.75-30），OB-VN 为 24 分钟（四分位距，19-27.75）（=0.5）。
TM-VN 对 MSU 上 tPA 给药的评估与 OB-VN 相当，不会导致治疗延迟。
