Loggini Andrea, Hornik Jonatan, Henson Jessie, Wesler Julie, Nelson Madison, Hornik Alejandro
Brain and Spine Institute, Southern Illinois Healthcare, Carbondale, IL, USA.
School of Medicine, Southern Illinois University, Carbondale, IL, USA.
Neurohospitalist. 2024 Oct;14(4):413-418. doi: 10.1177/19418744241276244. Epub 2024 Aug 20.
To determine if any difference exists in safety and outcomes of thrombolytic therapy for acute ischemic stroke administered via telemedicine, based on the subspeciality of the treating neurologist.
We performed a retrospective cross-sectional study using data from our local stroke registry of thrombolytic therapy administered via telemedicine at our rural stroke network over 5 years. The cohort was divided in 2 groups based on the subspecialty of the treating neurologist: vascular neurology (VN) and neurocritical care (NCC). Demographics, clinical characteristics, stroke metrics, thrombolytic complications, and final diagnosis were reviewed. In-hospital mortality and mRS and 30 days were noted.
Among 142 patients who received thrombolytic therapy via telemedicine, 44 (31%) were treated by VN specialists; 98 (69%) by NCC specialist. There was no difference in baseline characteristics and stroke metrics between the 2 groups. Compared to NCC, VN had a trend toward higher, but non-significant, sICH (6% vs 1%, = 0.05). In a logistic regression analysis, correcting for NIHSS, SBP, door-to-needle time, and use of antiplatelet therapy, the type of neurology subspecialty was not independently associated with development of sICH (OR: 0.141, SE: 0.188, = 0.141). The rate of in-hospital mortality was also similar between VN and NCC (7% vs 5%, = 0.8). In a model that accounted for stroke severity, no association was established between the type of neurology subspecialty and mRS at 30 days (OR: 1.589, SE: 0.662, = 0.266).
Safety and outcome of thrombolytic therapy via telemedicine was not influenced by the subspecialty of treating neurologist. Our study supports the expansion of telemedicine for acute stroke patients in rural and underserved areas.
基于治疗神经科医生的亚专业，确定通过远程医疗进行急性缺血性卒中溶栓治疗的安全性和疗效是否存在差异。
我们进行了一项回顾性横断面研究，使用了来自我们当地卒中登记处的数据，这些数据是关于我们农村卒中网络在5年期间通过远程医疗进行的溶栓治疗。根据治疗神经科医生的亚专业，该队列被分为两组：血管神经病学（VN）和神经重症监护（NCC）。对人口统计学、临床特征、卒中指标、溶栓并发症和最终诊断进行了回顾。记录了住院死亡率、改良Rankin量表（mRS）评分和30天情况。
在142例通过远程医疗接受溶栓治疗的患者中，44例（31%）由VN专科医生治疗；98例（69%）由NCC专科医生治疗。两组之间的基线特征和卒中指标没有差异。与NCC相比，VN有较高但无统计学意义的症状性颅内出血（sICH）趋势（6%对1%，P = 0.05）。在逻辑回归分析中，校正美国国立卫生研究院卒中量表（NIHSS）、收缩压、门到针时间和抗血小板治疗的使用后，神经科亚专业类型与sICH的发生没有独立相关性（比值比：0.141，标准误：0.188，P = 0.141）。VN和NCC的住院死亡率也相似（7%对5%，P = 0.8）。在一个考虑了卒中严重程度的模型中，神经科亚专业类型与30天时的mRS评分之间没有相关性（比值比：1.589，标准误：0.662，P = 0.266）。
通过远程医疗进行溶栓治疗的安全性和疗效不受治疗神经科医生亚专业的影响。我们的研究支持在农村和服务不足地区扩大针对急性卒中患者的远程医疗。
