德国东北部接受机械取栓术的院间转运患者的护理时间指标：农村地区的初级远程卒中中心与大城市地区的初级卒中中心对比

Time-to-care metrics in patients with interhospital transfer for mechanical thrombectomy in north-east Germany: Primary telestroke centers in rural areas vs. primary stroke centers in a metropolitan area.

作者信息

Riegler Christoph, Behrens Janina R, Gorski Claudia, Angermaier Anselm, Kinze Stephan, Ganeshan Ramanan, Rocco Andrea, Kunz Alexander, Müller Tobias J, Bitsch Andreas, Grüger Albert, Weber Joachim E, Siebert Eberhard, Bollweg Kerstin, von Rennenberg Regina, Audebert Heinrich J, Nolte Christian H, Erdur Hebun

机构信息

Klinik und Hochschulambulanz Für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.

出版信息

Front Neurol. 2023 Jan 9;13:1046564. doi: 10.3389/fneur.2022.1046564. eCollection 2022.

DOI:10.3389/fneur.2022.1046564

PMID:36698874

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9868735/

Abstract

BACKGROUND

Mechanical thrombectomy (MT) is highly effective in large vessel occlusion (LVO) stroke. In north-east Germany, many rural hospitals do not have continuous neurological expertise onsite and secondary transport to MT capable comprehensive stroke centers (CSC) is necessary. In metropolitan areas, small hospitals often have neurology departments, but cannot perform MT. Thus, interhospital transport to CSCs is also required. Here, we compare time-to-care metrics and outcomes in patients receiving MT after interhospital transfer from primary stroke centers (PCSs) to CSCs in rural vs. metropolitan areas.

METHODS

Patients from ten rural telestroke centers (RTCs) and nine CSCs participated in this study under the quality assurance registry for thrombectomies of the telestroke network. For the metropolitan area, we included patients admitted to 13 hospitals without thrombectomy capabilities (metropolitan primary stroke centers, MPSCs) and transferred to two CSCs. We compared groups regarding baseline variables, time-to-care metrics, clinical, and technical outcomes.

RESULTS

Between October 2018 and June 2022, 50 patients were transferred from RTCs within the ANNOTeM network and 42 from MPSCs within the Berlin metropolitan area. RTC patients were older (77 vs. 72 yrs, = 0.05) and had more severe strokes (NIHSS 17 vs. 10 pts., < 0.01). In patients with intravenous thrombolysis (IVT; 34.0 and 40.5%, respectively), time from arrival at the primary stroke center to start of IVT was longer in RTCs (65 vs. 37 min, < 0.01). However, RTC patients significantly quicker underwent groin puncture at CSCs (door-to-groin time: 42 vs. 60 min, < 0.01). Despite longer transport distances from RTCs to CSCs (55 vs. 22 km, < 0.001), there was no significant difference of times between arrival at the PSC and groin puncture (210 vs. 208 min, = 0.96). In adjusted analyses, there was no significant difference in clinical and technical outcomes.

CONCLUSION

Despite considerable differences in the setting of stroke treatment in rural and metropolitan areas, overall time-to-care metrics were similar. Targets of process improvement should be door-to-needle times in RTCs, transfer organization, and door-to-groin times in CSCs wherever such process times are above best-practice models.

摘要

背景

机械取栓术（MT）对大血管闭塞（LVO）性卒中疗效显著。在德国东北部，许多农村医院现场没有持续的神经科专业知识，因此有必要将患者二次转运至具备MT能力的综合卒中中心（CSC）。在大都市地区，小型医院通常设有神经科，但无法开展MT。因此，也需要将患者跨院转运至CSC。在此，我们比较了农村和大都市地区从初级卒中中心（PCS）转至CSC后接受MT治疗的患者的就医时间指标和治疗结果。

方法

来自10个农村远程卒中中心（RTC）和9个CSC的患者参与了这项基于远程卒中网络取栓质量保证登记的研究。对于大都市地区，我们纳入了13家无取栓能力医院（大都市初级卒中中心，MPSC）收治并转至2个CSC的患者。我们比较了两组患者的基线变量、就医时间指标、临床和技术结果。

结果

2018年10月至2022年6月期间，ANNOTeM网络内有50例患者从RTC转出，柏林大都市地区有42例患者从MPSC转出。RTC患者年龄更大（77岁对72岁，P = 0.05），卒中更严重（美国国立卫生研究院卒中量表[NIHSS]评分17分对10分，P < 0.01）。接受静脉溶栓（IVT）的患者（分别为34.0%和40.5%）中，RTC患者从到达初级卒中中心到开始IVT的时间更长（65分钟对37分钟，P < 0.01）。然而，RTC患者在CSC接受腹股沟穿刺的时间明显更快（门到腹股沟时间：42分钟对60分钟，P < 0.01）。尽管从RTC到CSC的转运距离更长（55公里对22公里，P < 0.001），但到达PCS和腹股沟穿刺之间的时间无显著差异（210分钟对208分钟，P = 0.96）。在调整分析中，临床和技术结果无显著差异。