Nalleballe Krishna, Sharma Rohan, Brown Aliza, Joiner Renee, Kapoor Nidhi, Morgan Tiffany, Benton Tina, Williamson Conelia, Culp William, Lowery Curtis, Onteddu Sanjeeva
Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, USA.
Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, USA.
J Telemed Telecare. 2020 Apr;26(3):174-179. doi: 10.1177/1357633X18805661. Epub 2018 Oct 23.
Studying critical time interval requirements can enhance thrombolytic treatment for stroke patients in telestroke networks. We retrospectively examined 12 concurrent months of targeted time interval information in the South Central US telemedicine programme, Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES).Hypothesis: We hypothesised that consult data analysis would highlight areas for improvement to shorten overall door to Intra venous (IV) tissue plasminogen activator (tPA) administration time.
We analysed critical time targets for 238 consecutive telestroke neurology consults obtained over 12 months from AR SAVES spoke sites when tPA was administered. The following time intervals were analysed: emergency department (ED) door to Computed Tomography (D-CT); ED door to call centre (D-CC) for initiation of consult; ED door to neurology call (D-NC); neurology call to camera (NC-Cam); tele consult time (Con); ED door to tissue plasminogen activator (tPA)/needle (DTN).
The median times of D-CT (13 min, inter quartile range (IQR) 6–22 min), D-CC (34 min, IQR 20–45 min), D-NC (40 min, IQR 21–71 min), NC-Cam (4 min, IQR 2–8 min), and Con (25 min, IQR 17–37 min) all contributed to a DTN median time of 71 min (IQR 50–104 min). A total of 238 patients received tPA with a 29.4% treatment rate and a DTN time of ≤60 min was achieved in 25.2% of patients.
Focusing on reducing D-CC and Con times may help to achieve the DTN time of < 60 min for the majority of patients. Having ideal time targets for telestroke patients akin to traditional patients will help identify and improve the overall goal of a DTN time < 60 min.
研究关键时间间隔要求可改善远程卒中网络中卒中患者的溶栓治疗。我们回顾性研究了美国中南部远程医疗项目“通过虚拟紧急支持实现阿肯色州卒中救助”（AR SAVES）连续12个月的目标时间间隔信息。
我们假设会诊数据分析将突出改进领域，以缩短从入院到静脉注射组织型纤溶酶原激活剂（tPA）的总时间。
我们分析了在12个月内从AR SAVES分支站点获得的238例连续远程卒中神经科会诊的关键时间目标，这些会诊均进行了tPA治疗。分析了以下时间间隔：急诊科（ED）入院到计算机断层扫描（D-CT）；ED入院到呼叫中心发起会诊（D-CC）；ED入院到神经科呼叫（D-NC）；神经科呼叫到摄像头（NC-Cam）；远程会诊时间（Con）；ED入院到组织型纤溶酶原激活剂（tPA）/穿刺（DTN）。
D-CT的中位时间（13分钟，四分位间距（IQR）6-22分钟）、D-CC（34分钟，IQR 20-45分钟）、D-NC（40分钟，IQR 21-71分钟）、NC-Cam（4分钟，IQR 2-8分钟）和Con（25分钟，IQR 17-37分钟）均导致DTN中位时间为71分钟（IQR 50-104分钟）。共有238例患者接受了tPA治疗，治疗率为29.4%，25.2%的患者DTN时间≤60分钟。
专注于减少D-CC和Con时间可能有助于大多数患者实现DTN时间<60分钟。为远程卒中患者设定与传统患者类似的理想时间目标将有助于确定并改善DTN时间<60分钟的总体目标。
