Department of Pharmacy, Morton Plant Hospital, Clearwater, Florida, United States.
Department of Pharmacy, Morton Plant Hospital, Clearwater, Florida, United States.
Am J Emerg Med. 2024 Dec;86:78-82. doi: 10.1016/j.ajem.2024.09.050. Epub 2024 Oct 2.
Intravenous thrombolysis remains the primary treatment for acute ischemic stroke (AIS); however, administration is time sensitive. Teleneurology services have increased in popularity in recent years due to their ability to aid in triaging patients with neurological conditions. Teleneurology services were implemented at this comprehensive stroke center, in August 2023 to aid in streamlining the administration of tenecteplase in AIS patients. Currently, there are no studies assessing whether the implementation of teleneurology services at a comprehensive stroke center influences tenecteplase door-to-needle time. The purpose of this study is to evaluate the difference in door-to-needle times when tenecteplase is administered with versus without a teleneurology consult.
This was an institutional review board approved, retrospective cohort study conducted at a single comprehensive stroke center. Adult patients who presented to the emergency department between January 1st, 2022 and April 1st, 2023 were included if they received tenecteplase for the treatment of AIS. The primary outcome was door-to-needle time, defined as the moment the patient first enters the door of the emergency department to the moment the IV bolus of fibrinolytic is administered. Secondary outcomes included the proportion of patients with door-to-needle time within 45 min, neurological improvement at 24 h and discharge, and rate of hemorrhagic conversion.
A total of 93 patients were included with 43 patients in the pre-teleneurology group and 50 patients in the post-teleneurology group. Baseline characteristics were comparable between both treatment groups. The median door-to-needle time was significantly reduced in the post-teleneurology group (49 minutes [IQR, 40.0-70.0] preintervention vs. 34.5 minutes [IQR, 23.8-43.0] postintervention, p < 0.01). For secondary outcomes, the post-teleneurology group had more patients with a door-to-needle time within 45 minutes (44.2% vs. 80.0%, p < 0.01). There was no significant difference in early neurological improvement (58.1% vs. 54.0%), neurological improvement at discharge (60.5% vs. 62.0%), or hemorrhagic conversion (7.0% vs. 12.0%).
Among patients who received tenecteplase for the treatment of AIS, there was a significant reduction in door-to-needle time with the use of teleneurology services. There was no difference in neurological improvement or rate of hemorrhagic conversion.
静脉溶栓仍然是急性缺血性脑卒中（AIS）的主要治疗方法；然而，治疗时间是敏感的。远程神经病学服务近年来因其能够帮助分诊神经疾病患者而越来越受欢迎。这家综合卒中中心于 2023 年 8 月引入远程神经病学服务，以简化 AIS 患者接受替奈普酶治疗的流程。目前，尚无研究评估综合卒中中心实施远程神经病学服务是否会影响替奈普酶的门到针时间。本研究旨在评估在有和没有远程神经病学咨询的情况下使用替奈普酶时门到针时间的差异。
这是一项机构审查委员会批准的回顾性队列研究，在一家综合卒中中心进行。如果患者在 2022 年 1 月 1 日至 2023 年 4 月 1 日期间因 AIS 接受替奈普酶治疗并进入急诊室，他们将被纳入本研究。主要结局是门到针时间，定义为患者首次进入急诊室门口到静脉推注纤维蛋白溶解剂的时间。次要结局包括 45 分钟内门到针时间的患者比例、24 小时和出院时的神经功能改善情况以及出血性转化发生率。
共纳入 93 例患者，其中 43 例在远程神经病学治疗前组，50 例在远程神经病学治疗后组。两组治疗前的基线特征相似。远程神经病学治疗后组的门到针时间中位数明显缩短（干预前 49 分钟[IQR，40.0-70.0] vs. 干预后 34.5 分钟[IQR，23.8-43.0]，p<0.01）。次要结局方面，远程神经病学治疗后组有更多的患者在 45 分钟内完成门到针时间（44.2% vs. 80.0%，p<0.01）。早期神经功能改善（58.1% vs. 54.0%）、出院时神经功能改善（60.5% vs. 62.0%）或出血性转化发生率（7.0% vs. 12.0%）无显著差异。
在接受替奈普酶治疗 AIS 的患者中，使用远程神经病学服务可显著缩短门到针时间。神经功能改善或出血性转化发生率无差异。
