Nalleballe Krishna, Brown Aliza, Sharma Rohan, Sheng Sen, Veerapaneni Poornachand, Patrice Kelly-Ann, Shah Vishank, Onteddu Sanjeeva, Culp William, Lowery Curtis, Benton Tina, Joiner Renee, Kapoor Nidhi
Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States.
Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States.
J Neurosci Rural Pract. 2020 Jul;11(3):403-406. doi: 10.1055/s-0040-1709362. Epub 2020 Jun 12.
There are still marked disparities in stroke care between rural and urban communities including difference in stroke-related mortality. We analyzed the efficiency of tissue plasminogen activator (tPA) delivery in the spoke sites in our telestroke network to assess impact of telecare in bridging these disparities. We analyzed critical time targets in our telestroke network. These included door-to-needle (DTN) time, door-to-CT (D2CT) time, door-to-call center, door-to-neurocall, and total consult time. We compared these time targets between the larger and smaller spoke hospitals. Across all the 52 spokes sites, a total of 825 stroke consults received intravenous tPA. When compared with larger hospitals (>200 beds), the smaller hospital groups with 0 to 25 and 51 to 100 beds had significantly lower D2CT time ( -value 0.01 and 0.005, respectively) and the ones with 26 to 50 and 151 to 200 beds had significantly lower consult time ( -value 0.009 and 0.001, respectively). There was no significant difference in the overall DTN time when all the smaller hospital groups were compared with larger hospitals. In our telestroke network, DTN times were not significantly affected by the hospital bed size. This shows that a protocol-driven telestroke network with frequent mock codes can ensure timely administration of tPA even in rural communities regardless of the hospital size and availability of local neurologists.
农村和城市社区在中风护理方面仍存在显著差异，包括中风相关死亡率的差异。我们分析了远程中风网络中各个分支站点组织型纤溶酶原激活剂（tPA）的给药效率，以评估远程护理在弥合这些差异方面的影响。
我们分析了远程中风网络中的关键时间指标。这些指标包括门到针（DTN）时间、门到CT（D2CT）时间、门到呼叫中心、门到神经科呼叫以及总会诊时间。我们比较了大小不同的分支医院之间的这些时间指标。
在所有52个分支站点中，共有825例中风会诊接受了静脉注射tPA。与大型医院（>200张床位）相比，床位为0至25张和51至100张的小型医院组的D2CT时间显著更短（P值分别为0.01和0.005），床位为26至50张和151至200张的小型医院组的会诊时间显著更短（P值分别为0.009和0.001）。当将所有小型医院组与大型医院进行比较时，总体DTN时间没有显著差异。
在我们的远程中风网络中，DTN时间不受医院床位规模的显著影响。这表明，一个由协议驱动、频繁进行模拟演练的远程中风网络，即使在农村社区，无论医院规模大小和当地神经科医生的可用性如何，都能确保及时给予tPA。
