Cossey T C, Jagolino Amanda, Ankrom Christy, Bambhroliya Arvind B, Cai Chunyan, Vahidy Farhaan S, Savitz Sean I, Wu Tzu-Ching
Institute for Stroke and Cerebrovascular Disease, Houston, TX; University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX.
Institute for Stroke and Cerebrovascular Disease, Houston, TX.
J Stroke Cerebrovasc Dis. 2019 Jan;28(1):198-204. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.035. Epub 2018 Nov 2.
Stroke outcomes have been shown to be worse for patients presenting overnight and on weekends (after-hours) to stroke centers compared with those presenting during business hours (on-hours). Telemedicine (TM) helps provide evaluation and safe management of stroke patients. We compared time metrics and outcomes of stroke patients who were assessed and received intravenous recombinant tissue plasminogen activator (IV-tPA) via TM during after-hours with those during on-hours.
Analysis of our TM registry from September 2015 to December 2016, identified 424 stroke patients who were assessed via TM and received IV-tPA. We compared baseline characteristics, clinical variables, time metrics, and outcomes between the after-hours (5 pm-7:59 am, weekends) and on-hours (weekdays 8 am-4:59 pm) patients.
Of the 424 patients, 268 were managed via TM during after-hours, and 156 during on-hours. Baseline characteristics and clinical variables were similar between the groups. Importantly, there were no differences in all relevant time metrics including door to IV-tPA bolus time. IV-tPA complications (including all intracerebral hemorrhage (ICH), any systemic bleeding, and angioedema), discharge disposition, and 90-day modified Rankin Scale were also similar in the groups.
There was no difference in IV-tPA treatment times, acute stroke evaluation times, or mortality between the patients treated after-hours versus on-hours. Unlike in-person neurology coverage at many centers, the coverage provided by TM does not differ depending on the hour or day. Access to stroke specialists 24/7 via TM can ensure dependable and timely clinical care for acute stroke patients regardless of the time of day or day of the week.
与在工作日营业时间（上班时间）就诊的患者相比，在夜间和周末（非工作时间）前往卒中中心就诊的患者，卒中预后更差。远程医疗（TM）有助于对卒中患者进行评估和安全管理。我们比较了在非工作时间通过远程医疗接受评估并接受静脉注射重组组织型纤溶酶原激活剂（IV-tPA）的卒中患者与在工作时间接受评估并接受IV-tPA的卒中患者的时间指标和预后。
分析我们2015年9月至2016年12月的远程医疗登记数据，确定了424例通过远程医疗接受评估并接受IV-tPA的卒中患者。我们比较了非工作时间（下午5点至上午7点59分，周末）和工作时间（工作日上午8点至下午4点59分）患者的基线特征、临床变量、时间指标和预后。
在这424例患者中，268例在非工作时间通过远程医疗进行管理，156例在工作时间进行管理。两组之间的基线特征和临床变量相似。重要的是，包括从入院到静脉注射tPA推注时间在内的所有相关时间指标均无差异。两组的IV-tPA并发症（包括所有颅内出血（ICH）、任何全身性出血和血管性水肿）、出院处置和90天改良Rankin量表评分也相似。
非工作时间治疗的患者与工作时间治疗的患者在IV-tPA治疗时间、急性卒中评估时间或死亡率方面没有差异。与许多中心的现场神经科诊疗不同，远程医疗提供的诊疗服务不会因时间或日期而异。通过远程医疗每周7天、每天24小时均可获得卒中专家的服务，这可以确保为急性卒中患者提供可靠且及时的临床护理，无论患者就诊的时间是白天还是晚上，是周中还是周末。
