Department of Neurology, University of Arkansas for Medical Sciences, USA.
Department of Radiology, University of Arkansas for Medical Sciences, USA.
J Telemed Telecare. 2020 Jul;26(6):317-321. doi: 10.1177/1357633X18824518. Epub 2019 Feb 10.
The purpose of this study was to determine reasons for not giving intravenous tissue plasminogen activator to eligible patients with acute ischemic stroke in a telestroke network.
We performed a retrospective analysis of prospectively collected data of patients who were seen as a telestroke consultation during 2015 and 2016 with the Arkansas Stroke Assistance through Virtual Emergency Support programme for possible acute ischemic stroke.
Total consultations seen were 809 in 2015 and 744 in 2016, out of which 238 patients in 2015 and 247 patients in 2016 received intravenous tissue plasminogen activator. In 2015 and 2016, out of the remaining 571 and 497 patients, 294 and 200 patients respectively were thought to be cases of acute stroke based on clinical evaluation. The most common reasons for not being treated in 2015 and 2016, respectively, were; (a) minimal deficits in 42.17% and 49.5% cases, (b) falling out of the 4.5-hour time window in 22.44% and 22% cases, (c) patient/next of kin refusal in 18.02% and 16.5% cases. Less common reasons included limited functional status, abnormal labs (thrombocytopenia, elevated international normalised ratio (INR)/prothrombin time (PT)/partial thromboplastin time (PTT), hypo or hyperglycemia etc), recent surgery and symptoms being too severe etc.
'Minimal deficits' and 'out of time window' continue to be the major causes for not receiving thrombolysis during acute ischemic stroke in both traditional and telestroke systems. Patient/next of kin refusal was high in our telestroke system when compared to traditional practices. Considering the increasing utility of telestroke this needs to be further looked into, along with the ways to address it.
本研究旨在确定在远程卒中网络中，对符合条件的急性缺血性卒中患者不给予静脉组织型纤溶酶原激活剂的原因。
我们对 2015 年和 2016 年通过阿肯色州卒中远程协助虚拟急救支持计划接受远程卒中咨询的可能急性缺血性卒中患者前瞻性收集的数据进行了回顾性分析。
2015 年总咨询量为 809 例，2016 年为 744 例，其中 2015 年 238 例和 2016 年 247 例患者接受了静脉组织型纤溶酶原激活剂治疗。2015 年和 2016 年，在剩余的 571 例和 497 例患者中，分别有 294 例和 200 例患者根据临床评估被认为患有急性卒中。2015 年和 2016 年未接受治疗的最常见原因分别为：（a）42.17%和 49.5%的患者存在轻微缺损，（b）22.44%和 22%的患者超出 4.5 小时时间窗，（c）18.02%和 16.5%的患者因患者/家属拒绝。较少见的原因包括功能状态受限、实验室异常（血小板减少、国际标准化比值（INR）/凝血酶原时间（PT）/部分凝血活酶时间（PTT）升高、低血糖或高血糖等）、近期手术和症状过于严重等。
“轻微缺损”和“超出时间窗”仍是传统和远程卒中系统中急性缺血性卒中患者未接受溶栓治疗的主要原因。与传统实践相比，我们的远程卒中系统中患者/家属拒绝的比例较高。考虑到远程卒中的应用越来越广泛，需要进一步研究并解决这一问题。
