远程卒中咨询在急救医疗服务单元中的应用：一种改善溶栓时间的新方法。
Telestroke Consultation in the Emergency Medical Services Unit: A Novel Approach to Improve Thrombolysis Times.
机构信息
Neurology, Medical University of South Carolina, Charleston, SC, United States; Neurosurgery, Medical University of South Carolina, Charleston, SC, United States.
Neurology, Medical University of South Carolina, Charleston, SC, United States.
出版信息
J Stroke Cerebrovasc Dis. 2021 May;30(5):105710. doi: 10.1016/j.jstrokecerebrovasdis.2021.105710. Epub 2021 Mar 6.
BACKGROUND
Faster treatment times are associated with improved outcomes in patients with acute ischemic stroke. In this prospective pilot study, we assess the feasibility of initiating telestroke consultation in emergency medical services unit (TEMS).
METHODS
Patients with stroke symptoms were evaluated via TEMS using a video-call with a stroke provider. After TEMS evaluation, patients were transferred to the nearest stroke center (NSC) or thrombectomy capable center (TCS) depending on stroke severity and symptom onset time. We compared time metrics between patients evaluated via TEMS to those via standard telestroke (STS) consultation.
RESULTS
49 patients were evaluated via TEMS between May 2017 and March 2020. Median age was 66, 24 (49%) were females, 15 (30.6%) received intravenous alteplase (tPA) after arrival to a local hospital, and 3 (6.1%) underwent mechanical thrombectomy (MT) after bypassing the NSC. Compared to 52 tPA patients treated through STS consultation, TEMS patients had shorter door to needle (DTN) time (21 vs. 38 min, p < 0.001). In addition, patients who received MT after bypassing the NSC had shorter onset to groin time compared to those transferred from NSC (216 vs. 293 min, P = 0.04).
CONCLUSION
Prehospital stroke triaging using TEMS is feasible, and could result in shorter DTN and onset to groin times.
背景
更快的治疗时间与急性缺血性脑卒中患者的改善预后相关。在这项前瞻性试点研究中，我们评估了在急诊医疗服务单元（TEMS）中启动远程卒中咨询的可行性。
方法
通过 TEMS 使用与卒中提供者的视频通话对具有卒中症状的患者进行评估。TEMS 评估后，根据卒中严重程度和症状发作时间将患者转至最近的卒中中心（NSC）或可进行取栓术的中心（TCS）。我们比较了通过 TEMS 评估的患者与通过标准远程卒中（STS）咨询评估的患者的时间指标。
结果
2017 年 5 月至 2020 年 3 月期间，通过 TEMS 评估了 49 例患者。中位年龄为 66 岁，24 例（49%）为女性，15 例（30.6%）在到达当地医院后接受了静脉内阿替普酶（tPA）治疗，3 例（6.1%）在绕过 NSC 后进行了机械取栓术（MT）。与通过 STS 咨询治疗的 52 例 tPA 患者相比，TEMS 患者的门到针（DTN）时间更短（21 分钟 vs. 38 分钟，p<0.001）。此外，绕过 NSC 后接受 MT 的患者与从 NSC 转来的患者相比，发病至股动脉时间更短（216 分钟 vs. 293 分钟，P=0.04）。
结论
使用 TEMS 进行院前卒中分诊是可行的，并且可能导致 DTN 和发病至股动脉时间更短。
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