Blech Benzion, O'Carroll Cumara B, Zhang Nan, Demaerschalk Bart M
Department of Neurology, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona.
Division of Health Sciences Research, Mayo Clinic College of Medicine and Science, Scottsdale, Arizona.
Telemed J E Health. 2020 Apr;26(4):406-410. doi: 10.1089/tmj.2018.0336. Epub 2019 Jul 9.
Background:Telestroke can provide indispensable expert stroke care for rural hospitals. The Stroke Telemedicine for Arizona Rural Residents program was developed in 2006 by Mayo Clinic to provide stroke expertise across the region. However, little data currently exist to determine whether this telestroke program had an impact on accepted acute stroke care metrics, such as door-to-needle time.
Hypothesis:Participation of spoke sites in a telestroke program improves stroke care over time, as defined by currently accepted metrics, such as door-to-needle time.
Methods:A retrospective analysis was performed on the telestroke database from Mayo Clinic Arizona between the years of 2011 to 2018. All patients with a diagnosis of acute ischemic stroke, who underwent a telestroke consultation and received intravenous alteplase were included in the analysis. Univariate linear regression was performed to look for associations between variables and defined outcomes.
Results:A total of 563 patients were identified who met inclusion criteria. Average last-known normal to needle times decreased across all telestroke participating spoke sites from 176 to 147 min, with univariate linear regression showing a trend of decreased time of 3.4 min per year, which was statistically significant (p = 0.0042). Average door-to-needle times decreased from 112 to 81 min, with univariate linear regression modeling showing a decreasing trend of 3.7 min per year (p < 0.0001).
Conclusions:Telestroke network participation may be associated with improved acute stroke care metrics over time, with the analysis illustrating improved last-known normal to needle and door-to-needle times among participating spoke sites.
远程卒中可为农村医院提供不可或缺的专业卒中护理。梅奥诊所于2006年开展了亚利桑那农村居民卒中远程医疗项目，以在整个地区提供卒中专业知识。然而，目前几乎没有数据来确定这个远程卒中项目是否对公认的急性卒中护理指标产生了影响，如门到针时间。
随着时间的推移，作为目前公认指标（如门到针时间）所定义的，卒中远程医疗项目中基层站点的参与可改善卒中护理。
对2011年至2018年期间梅奥诊所亚利桑那分院的远程卒中数据库进行回顾性分析。所有诊断为急性缺血性卒中、接受远程卒中会诊并接受静脉注射阿替普酶的患者均纳入分析。进行单变量线性回归以寻找变量与既定结果之间的关联。
共确定了563名符合纳入标准的患者。在所有参与远程卒中的基层站点中，平均最后已知正常时间到针时间从176分钟降至147分钟，单变量线性回归显示每年时间减少3.4分钟的趋势，具有统计学意义（p = 0.0042）。平均门到针时间从112分钟降至81分钟，单变量线性回归模型显示每年减少3.7分钟的趋势（p < 0.0001）。
随着时间的推移，参与远程卒中网络可能与改善急性卒中护理指标相关，分析表明参与的基层站点的最后已知正常时间到针时间和门到针时间有所改善。
