Almallouhi Eyad, Ajinkya Shaun, Rahwan Mohamad, Holmstedt Christine A, Al Kasab Sami
Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
Telemed J E Health. 2021 Feb;27(2):167-171. doi: 10.1089/tmj.2020.0020. Epub 2020 May 12.
Previous studies have shown that primary stroke centers (PSCs) have shorter door to needle (DTN) time than non-PSCs hospitals. We aimed to validate these findings in a high-volume telestroke network. The prospectively maintained data on all consecutive stroke patients who received intravenous alteplase (tissue plasminogen activator [tPA]) between July 2016 and November 2019 through a large telestroke program in Southeast United States was reviewed. Wilcoxon Rank-sum (Mann-Whitney) test was used to compare median times between different groups. Multivariate logistic regression model was used to assess the association between presenting to PSC and having DTN ≤45 and ≤60 min. During the study period, 1,517 patients received tPA, 874 (57.6%) at PSC sites. There were more white patients in the PSC group (64.3%) compared to non-PSC group (58%) (p < 0.001). Other characteristics were similar in patients in both groups. Time metrics were as follows, Door to telestroke page: 16 min versus 13 min (p < 0.001), telestroke page to tPA recommendation: 23 min versus 22 min (p = 0.975), tPA recommendation to tPA bolus administration: 13 min versus 10 min (p < 0.001), and DTN 58 min versus 49 min (p < 0.001) at non-PSC and PSC sites, respectively. On multivariate analysis, there were significantly higher odds for achieving a DTN ≤45 min (OR 2.8, 95% CI 1.8-4.4, p < 0.001) and DTN ≤60 min (OR 3, 95% CI 2.1-4.3, p < 0.001) in the PSC group. In our study, PSCs had better performance in the procedural metrics for tPA administration than non-PSCs in a large contemporary telestroke cohort.
先前的研究表明，初级卒中中心（PSC）的门到针（DTN）时间比非PSC医院更短。我们旨在通过一个大容量远程卒中网络验证这些发现。回顾了2016年7月至2019年11月期间，通过美国东南部一个大型远程卒中项目接受静脉注射阿替普酶（组织纤溶酶原激活剂[tPA]）的所有连续性卒中患者的前瞻性维护数据。采用Wilcoxon秩和（Mann-Whitney）检验比较不同组之间的中位数时间。使用多变量逻辑回归模型评估就诊于PSC与DTN≤45分钟和≤60分钟之间的关联。在研究期间，1517例患者接受了tPA治疗，其中874例（57.6%）在PSC机构。与非PSC组（58%）相比，PSC组白人患者更多（64.3%）（p<0.001）。两组患者的其他特征相似。时间指标如下，到达远程卒中呼叫的时间：16分钟对13分钟（p<0.001），远程卒中呼叫至tPA推荐时间：23分钟对22分钟（p=0.975），tPA推荐至tPA推注给药时间：13分钟对10分钟（p<0.001），非PSC和PSC机构的DTN分别为58分钟对49分钟（p<0.001）。多变量分析显示，PSC组实现DTN≤45分钟（OR 2.8，95%CI 1.8-4.4，p<0.001）和DTN≤60分钟（OR 3，95%CI 2.1-4.3，p<0.001）的几率显著更高。在我们的研究中，在一个大型当代远程卒中队列中，PSC在tPA给药的程序指标方面比非PSC表现更好。
