Istanbul Cam and Sakura City Hospital Department of Emergency Medicine, University of Health Sciences, Istanbul, Turkey.
Department of Emergence Medicine, Republic of Turkey, Ministry of Health Başaksehir Cam and Sakura State Hospital, Istanbul, Turkey.
Ir J Med Sci. 2024 Apr;193(2):1019-1024. doi: 10.1007/s11845-023-03497-1. Epub 2023 Aug 19.
Recently, telemedicine has become a widely used method worldwide for the treatment of patients with acute ischemic stroke in hospitals where neurologists are unavailable. The purpose of this study was to determine the accuracy and reliability of treatment decisions made by remote neurologists via teleconference assisted by emergency physicians in acute stroke cases and to determine whether the use of teleconsultation would lead to any delays in assessment and treatment decisions.
This single-center and prospective study was performed with 104 patients who met the inclusion criteria. Patients were concurrently assessed by a teleneurologist (TN) experienced in stroke and an on-site neurologist (OS-N). The TN performed their assessment via teleconference and assisted by an emergency physician for test results and physical examination. NIHSS (The National Institutes of Health Stroke Scale) scores, assessment times, treatment decisions by the two neurologists, and patient outcomes were recorded separately. The TN was asked to rate the quality of communication.
Of the 104 patients in the study, 59.6% (n = 62) were men and the median age was 66 (interquartile range = 56-78) years. The median duration of assessment by the OS-N was 30 (18-45) min and the median duration of assessment by the TN was 6 (5-8) min; the duration of assessment by the TN was significantly shorter (6.56 min vs. 33.35 min; Z = 8.669; p < 0.001). The median rating assigned by the TN to the quality of teleconsultation was 5.0 (4.25-5.0) (Table 1). The NIHSS scores assigned by both neurologists showed significant correlation (p < 0.001). Analysis of the agreement between the OS-N and TN in their treatment decisions yielded a Kappa value of 74.3% for interrater agreement.
Teleconsultation was a successful and reliable strategy in assessing patients with ischemic stroke and making decisions for IV-tPA. Moreover, patient assessment via teleconsultation was less time consuming. The results of the study are promising for the use of teleconsultation in the future.
最近，远程医疗已成为全球范围内在缺乏神经科医生的医院中治疗急性缺血性脑卒中患者的一种广泛应用的方法。本研究旨在确定通过远程神经科医生通过远程会议协助急诊医生在急性脑卒中病例中做出的治疗决策的准确性和可靠性，并确定使用远程会诊是否会导致评估和治疗决策的延迟。
这项单中心前瞻性研究纳入了符合纳入标准的 104 名患者。患者同时由远程神经科医生（TN）和现场神经科医生（OS-N）进行评估。TN 通过远程会议并由急诊医生协助进行测试结果和体格检查进行评估。记录 NIHSS（国立卫生研究院卒中量表）评分、两名神经科医生的评估时间、治疗决策以及患者结局。要求 TN 对沟通质量进行评分。
研究中的 104 名患者中，59.6%（n=62）为男性，中位年龄为 66（四分位间距=56-78）岁。OS-N 的评估中位时长为 30（18-45）分钟，TN 的评估中位时长为 6（5-8）分钟；TN 的评估时长明显更短（6.56 分钟比 33.35 分钟；Z=8.669；p<0.001）。TN 对远程咨询质量的中位数评分为 5.0（4.25-5.0）（表 1）。两名神经科医生的 NIHSS 评分均显示出显著相关性（p<0.001）。分析 OS-N 和 TN 治疗决策的一致性，其一致性的 Kappa 值为 74.3%。
远程咨询是评估缺血性脑卒中患者和制定 IV-tPA 治疗决策的一种成功且可靠的策略。此外，通过远程咨询进行患者评估所需时间更短。该研究结果为未来远程咨询的应用提供了希望。
