远程卒中网络中的 CTA 协议提高了辐辏医院和枢纽医院的效率。
CTA Protocols in a Telestroke Network Improve Efficiency for Both Spoke and Hub Hospitals.
机构信息
From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.).
Neurosurgery (R.W.R., A.B.P., C.J.S., T.M.L.-M.).
出版信息
AJNR Am J Neuroradiol. 2021 Mar;42(3):435-440. doi: 10.3174/ajnr.A6950. Epub 2021 Feb 4.
BACKGROUND AND PURPOSE
Telestroke networks support screening for patients with emergent large-vessel occlusions who are eligible for endovascular thrombectomy. Ideal triage processes within telestroke networks remain uncertain. We characterize the impact of implementing a routine spoke hospital CTA protocol in our integrated telestroke network on transfer and thrombectomy patterns.
MATERIALS AND METHODS
A protocol-driven CTA process was introduced at 22 spoke hospitals in November 2017. We retrospectively identified prospectively collected patients who presented to a spoke hospital with National Institutes of Health Stroke Scale scores ≥6 between March 1, 2016 and March 1, 2017 (pre-CTA), and March 1, 2018 and March 1, 2019 (post-CTA). We describe the demographics, CTA utilization, spoke hospital retention rates, emergent large-vessel occlusion identification, and rates of endovascular thrombectomy.
RESULTS
There were 167 patients pre-CTA and 207 post-CTA. The rate of CTA at spoke hospitals increased from 15% to 70% (< .001). Despite increased endovascular thrombectomy screening in the extended window, the overall rates of transfer out of spoke hospitals remained similar (56% versus 54%; = .83). There was a nonsignificant increase in transfers to our hub hospital for endovascular thrombectomy (26% versus 35%; = .12), but patients transferred >4.5 hours from last known well increased nearly 5-fold (7% versus 34%; < .001). The rate of endovascular thrombectomy performed on patients transferred for possible endovascular thrombectomy more than doubled (22% versus 47%; = .011).
CONCLUSIONS
Implementation of CTA at spoke hospitals in our telestroke network was feasible and improved the efficiency of stroke triage. Rates of patients retained at spoke hospitals remained stable despite higher numbers of patients screened. Emergent large-vessel occlusion confirmation at the spoke hospital lead to a more than 2-fold increase in thrombectomy rates among transferred patients at the hub.
背景与目的
远程卒中网络支持对有资格接受血管内血栓切除术的大血管闭塞急诊患者进行筛查。远程卒中网络内理想的分诊流程仍不确定。我们描述了在我们的综合远程卒中网络中实施常规辐辏医院 CTA 方案对转移和血栓切除术模式的影响。
材料与方法
2017 年 11 月，在 22 家辐辏医院引入了一项基于方案的 CTA 流程。我们回顾性地确定了在 NIHSS 评分≥6 的情况下于 2016 年 3 月 1 日至 2017 年 3 月 1 日（CTA 前）和 2018 年 3 月 1 日至 2019 年 3 月 1 日（CTA 后）期间到辐辏医院就诊的前瞻性收集患者。我们描述了人口统计学、CTA 使用率、辐辏医院保留率、紧急大血管闭塞的识别以及血管内血栓切除术的发生率。
结果
CTA 前有 167 例患者，CTA 后有 207 例患者。辐辏医院的 CTA 使用率从 15%增加到 70%（<0.001）。尽管在扩展窗口内进行了更多的血管内血栓切除术筛查，但辐辏医院的整体转出率仍相似（56%比 54%；=0.83）。我们的中心医院进行血管内血栓切除术的转诊略有增加（26%比 35%；=0.12），但从最后一次已知的健康状态起超过 4.5 小时的转诊增加了近 5 倍（7%比 34%；<0.001）。转诊接受可能的血管内血栓切除术的患者中，进行血管内血栓切除术的比例翻了一番多（22%比 47%；=0.011）。
结论
在我们的远程卒中网络中，在辐辏医院实施 CTA 是可行的，并且提高了卒中分诊的效率。尽管筛选的患者数量增加，但辐辏医院保留的患者比例保持稳定。在辐辏医院确认紧急大血管闭塞导致在中心医院进行转院的患者中，血栓切除术的比例增加了两倍多。
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