Department of Neurology, Yuanlin Christian Hospital, Yuanlin, Taiwan.
Department of Radiology, Yuanlin Christian Hospital, Yuanlin, Taiwan.
J Formos Med Assoc. 2022 Jan;121(1 Pt 2):314-318. doi: 10.1016/j.jfma.2021.04.024. Epub 2021 May 13.
Telemedicine helps to provide the safe management of stroke patients in the emergency department (ED) and has been used worldwide. However, we had limited experience of telestroke in Taiwan. We aimed to identify the quality of telestroke and compare it with the original face-to-face consultation model.
Among 178 consecutive acute ischemic stroke patients treated with intravenous tissue plasminogen activator (IVtPA) from January 1, 2018, to December 31, 2019, we compared two different consultation methods: face-to-face consultation and telestroke consultation. We collected data on demographics, the National Institutes of Health Stroke Scale (NIHSS) scores, Modified Rankin Scale (mRS) scores, time measurements (onset-to-arrival time, onset-to-telestroke activation time, and time of IVtPA administration (Door-to-Needle; DTN)).
The mean age to receive a telestroke consultation was 66.6 years, 36% were female, and the median NIHSS score was 9. The median time from patient arrival to telestroke consult activation was 40 min, and the median DTN time was 11 min longer than for face-to-face consults (62 min versus 51 min, p = .01). Telestroke consultation, similar to a face-to-face consultation, resulted in safe IVtPA eligibility assessments and administration with post-thrombolysis ICH in 4% overall (4% telestroke, 3% face-to-face consultation; p = .851). The 90-day outcomes were not different for mRS score, dichotomized 0-2 (60% telestroke 59% face-to-face consultation; p = .961), or for mortality (16% telestroke, 9% face-to-face consultation; p = .292).
In the ED, consultation via the telestroke program provides equal quality to the original face-to-face consultation model to manage ischemic stroke.
远程医疗有助于在急诊科（ED）安全管理中风患者，并且已经在全球范围内使用。然而，我们在台湾的远程卒中经验有限。我们旨在确定远程卒中的质量，并将其与原始的面对面咨询模式进行比较。
在 2018 年 1 月 1 日至 2019 年 12 月 31 日期间，连续 178 例接受静脉注射组织型纤溶酶原激活剂（IVtPA）治疗的急性缺血性卒中患者中，我们比较了两种不同的咨询方式：面对面咨询和远程卒中咨询。我们收集了人口统计学数据、国立卫生研究院卒中量表（NIHSS）评分、改良Rankin 量表（mRS）评分、时间测量（发病至到达时间、发病至远程卒中激活时间以及 IVtPA 给药时间（门到针；DTN））。
接受远程卒中咨询的患者平均年龄为 66.6 岁，36%为女性，NIHSS 中位数为 9 分。从患者到达到远程卒中咨询激活的中位时间为 40 分钟，DTN 时间比面对面咨询长 11 分钟（62 分钟对 51 分钟，p=0.01）。远程卒中咨询与面对面咨询一样，导致安全的 IVtPA 资格评估和给药，总体后溶栓 ICH 发生率为 4%（远程卒中 4%，面对面咨询 3%；p=0.851）。90 天结局在 mRS 评分方面无差异，二分类为 0-2（远程卒中 60%，面对面咨询 59%；p=0.961），或死亡率（远程卒中 16%，面对面咨询 9%；p=0.292）。
在 ED，通过远程卒中计划进行咨询可提供与原始面对面咨询模式相同的质量，以管理缺血性卒中。
