From the Department of Neurology (N.A.W., A.B., C. Ankrom, F.V., C. Astudillo, A.T., R.M., T.C.C., A.J.-C., S.S., T.-C.W., A.S.), McGovern Medical School, University of Texas Health Sciences Center at Houston.
Institute for Stroke and Cerebrovascular Disease (F.V., T.C.C., A.J.-C., S.S., T.-C.W., A.S.), McGovern Medical School, University of Texas Health Sciences Center at Houston.
Stroke. 2019 Apr;50(4):895-900. doi: 10.1161/STROKEAHA.118.024703.
Background and Purpose- Telemedicine is increasingly utilized for intravenous tPA (tissue-type plasminogen activator) delivery. The comparative safety of leaving tPA-treated patients at a presenting (spoke) hospital (drip-and-stay) or transferring patients to a central treating (hub) hospital (drip-and-ship) is not established. We sought to compare outcomes between drip-and-ship and drip-and-stay patients treated with tPA via telemedicine. We hypothesized that there would be no differences in short-term outcomes of in-hospital mortality, length of stay, or discharge disposition or in 90-day outcomes between groups. Methods- We retrospectively identified patients treated with tPA at 17 spoke hospitals between September 2015 and December 2016. Demographic, clinical, and outcome data were obtained from a prospective telemedicine registry. We used negative binomial, multinomial, and logistic regression analyses to evaluate length of stay, discharge disposition, and inpatient mortality, respectively. We compared the proportion of patients with 90-day modified Rankin Scale score <2 by group. Results- Among 430 tPA-treated patients, 232 (53.9%) were transferred to the hub after treatment. The median arrival National Institutes of Health Stroke Scale score was higher for drip-and-ship (10; interquartile range, 5-18) compared with drip-and-stay patients (6; interquartile range, 4-10; P<0.001). Unadjusted length of stay was longer in drip-and-stay patients (incidence rate ratio, 0.82; 95% CI, 0.71-0.95). There were no significant differences in adjusted length of stay, hospital mortality, or discharge disposition. Among the 64% of patients with complete 90-day modified Rankin Scale score, the proportion with good outcomes (modified Rankin Scale score <2) did not differ between groups. Conclusions- We found no differences in measured outcomes between drip-and-ship and drip-and-stay patients treated in our network, although our study may be underpowered to detect small differences.
背景与目的-远程医疗越来越多地用于静脉注射 tPA（组织型纤溶酶原激活物）。将接受 tPA 治疗的患者留在就诊医院（滴注并停留）或转送至中心治疗医院（滴注并转运）的相对安全性尚未确定。我们旨在比较通过远程医疗接受 tPA 治疗的滴注并转运和滴注并停留患者的结局。我们假设两组患者在院内死亡率、住院时间、出院去向或 90 天结局方面无差异。方法-我们回顾性地确定了 2015 年 9 月至 2016 年 12 月期间在 17 家就诊医院接受 tPA 治疗的患者。从一项前瞻性远程医疗登记处获取人口统计学、临床和结局数据。我们分别使用负二项式、多项和逻辑回归分析评估住院时间、出院去向和院内死亡率。我们比较了两组患者在 90 天改良 Rankin 量表评分<2 的比例。结果-在 430 例接受 tPA 治疗的患者中，有 232 例（53.9%）在治疗后转至中心。滴注并转运组的中位入院国立卫生研究院卒中量表评分较高（10；四分位间距，5-18），而滴注并停留组的评分较低（6；四分位间距，4-10；P<0.001）。未校正的住院时间在滴注并停留组更长（发病率比，0.82；95%CI，0.71-0.95）。校正后的住院时间、院内死亡率或出院去向无显著差异。在 90 天改良 Rankin 量表评分完整的 64%患者中，两组患者的良好结局（改良 Rankin 量表评分<2）比例无差异。结论-尽管我们的研究可能无法检测到微小差异，但我们未发现网络内接受滴注并转运和滴注并停留治疗的患者在测量结局方面的差异。
