Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis

被引:56
|
作者
Taqui, Ather [1 ]
Cerejo, Russell [1 ]
Itrat, Ahmed [1 ]
Briggs, Farren B. S. [4 ]
Reimer, Andrew P. [3 ,5 ]
Winners, Stacey [1 ]
Organek, Natalie [2 ]
Buletko, Andrew B. [2 ]
Sheikhi, Lila [2 ]
Cho, Sung-Min [2 ]
Buttrick, Maureen [1 ]
Donohue, Megan M. [1 ]
Khawaja, Zeshaun [1 ]
Wisco, Dolora [1 ]
Frontera, Jennifer A. [1 ]
Russman, Andrew N. [1 ]
Hustey, Fredric M. [3 ]
Kralovic, Damon M. [3 ]
Rasmussen, Peter [1 ]
Uchino, Ken [1 ]
Hussain, Muhammad S. [1 ]
Group, P. H. A. S. T.
机构
[1] Cerebrovasc Ctr, Cleveland Clin, Cleveland, OH 44195 USA
[2] Cleveland Clin, Dept Neurol, Cleveland, OH 44195 USA
[3] Cleveland Clin, Crit Care Transport Team, Cleveland, OH 44195 USA
[4] Case Western Reserve Univ, Sch Med, Dept Epidemiol & Biostat, Cleveland, OH 44195 USA
[5] Case Western Reserve Univ, Frances Payne Bolton Sch Nursing, Cleveland, OH 44195 USA
关键词
MOBILE STROKE UNIT; ISCHEMIC-STROKE; DELAY; GUIDELINES; MANAGEMENT; ALTEPLASE; MINUTES;
D O I
10.1212/WNL.0000000000003786
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To compare the times to evaluation and thrombolytic treatment of patients treated with a telemedicine-enabled mobile stroke treatment unit (MSTU) vs those among patients brought to the emergency department (ED) via a traditional ambulance. Methods: We implemented a MSTU with telemedicine at our institution starting July 18, 2014. A vascular neurologist evaluated each patient via telemedicine and a neuroradiologist and vascular neurologist remotely assessed images obtained by theMSTUCT. Data were entered in a prospective registry. The evaluation and treatment of the first 100 MSTU patients (July 18, 2014-November 1, 2014) was compared to a control group of 53 patients brought to the ED via a traditional ambulance in 2014. Times were expressed as medians with their interquartile ranges. Results: Patient and stroke severity characteristics were similar between 100 MSTU and 53 ED control patients (initial NIH Stroke Scale score 6 vs 7, p = 0.679). There was a significant reduction of median alarm-to-CT scan completion times (33 minutes MSTU vs 56 minutes controls, p < 0.0001), median alarm-to-thrombolysis times (55.5 minutes MSTU vs 94 minutes controls, p < 0.0001), median door-to-thrombolysis times (31.5 minutes MSTU vs 58 minutes controls, p = 0.0012), and symptom-onset-to-thrombolysis times (97 minutes MSTU vs 122.5 minutes controls, p 5 0.0485). Sixteen patients evaluated on MSTU received thrombolysis, 25% of whom received it within 60 minutes of symptom onset. Conclusion: Compared with the traditional ambulance model, telemedicine-enabled ambulancebased thrombolysis resulted in significantly decreased time to imaging and treatment.
引用
收藏
页码:1305 / 1312
页数:8
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