眼科在远程卒中会诊中对急性视力丧失分流的作用。

IF 1.5 Q3 EMERGENCY MEDICINE
Open Access Emergency Medicine Pub Date : 2024-02-05 eCollection Date: 2024-01-01 DOI:10.2147/OAEM.S395588
Anna Artymowicz, Christina Douglas, Kimberly Cockerham
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引用次数: 0

摘要

远程医疗的发展使医生能够在以前地理位置或实际上无法到达的地区提供医疗服务。美国约有 70% 的医院床位数不足 200 张,近 50% 的医院床位数不足 100 张。这些规模较小的医院通常没有专家为病人提供床边护理,因此成为远程医疗专科服务的潜在受益者。2005 年,美国卒中协会提议实施远程医疗服务,以增加神经病学服务不足地区(如小型医院)获得急性卒中治疗的机会。自此,远程卒中服务在全美范围内普及开来,目前约有 30% 的美国医院使用远程卒中服务。通过缩短患者从就诊到卒中专家评估之间的时间,远程卒中项目成功地增加了患者获得组织浆蛋白原激活剂(t-PA)救命治疗的机会。这一变化在偏远地区和服务不足的社区医院尤为显著。然而,在评估急性视力丧失这一眼科与中风治疗重叠的领域时,对远程中风服务的日益依赖带来了一些独特的挑战。急性视力的鉴别很复杂,通常是中风以外的其他疾病引起的。当远程中风服务被用于评估急性视力丧失时,神经科医生需要在没有完整眼部信息的情况下做出医疗决定。这种情况可能使患者接受昂贵或不适当的检查、不必要的住院治疗,或导致眼部非神经疾病的诊断和治疗延误。本文旨在概述中风与视力丧失之间的重叠,强调使用远程中风评估急性视力丧失所固有的挑战,并就如何加强急诊医学、眼科和神经内科之间的沟通以确保视力丧失患者在所有医院都能得到最高标准的治疗提出我们的看法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Role of Ophthalmology in Tele-Stroke Consults for Triaging Acute Vision Loss.

Advances in telemedicine have allowed physicians to provide care in areas that were previously geographically or practically inaccessible. Roughly 70% of all US hospital have less than 200 bed capacity and nearly 50% have fewer than 100 beds. These smaller hospitals often do not have specialists available for bedside patient care, making them potential beneficiaries of telemedicine medical specialty services. In 2005, the American Stroke Association proposed implementing telemedicine services in effort to increase access to acute stroke care in neurologically underserved areas such as small hospitals. Tele-stroke services have since become established across the country and are now utilized by approximately 30% of US hospitals. By reducing the time between presentation and evaluation by a stroke specialist, tele-stroke programs have successfully increased patient access to life-saving treatment with tissue-plasminogen activator (t-PA) treatments. This change has been especially profound remote and underserved community hospitals. However in the evaluation of acute vision loss, an area where ophthalmology and stroke care overlap, increased reliance on tele-stroke services has contributed to some unique challenges. Acute vision has a complex differential and is commonly a result of conditions other than stroke. When tele-stroke services are engaged for the evaluation of acute vision loss, the neurologist is asked to make medical decisions without complete information about the eye. This situation can expose patients to costly or inappropriate testing, unnecessary hospitalizations, or lead to delayed diagnosis and treatment of non-neurologic conditions of the eye. The goal of this paper is to provide an overview of the overlap between stroke and vision loss, highlight the challenges inherent in using tele-stroke in evaluating acute vision loss and to offer our comments on how increased communication between emergency medicine, ophthalmology, and neurology services can ensure that patients with vision loss receive the highest standard of care in all hospitals.

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来源期刊
Open Access Emergency Medicine
Open Access Emergency Medicine EMERGENCY MEDICINE-
CiteScore
2.60
自引率
6.70%
发文量
85
审稿时长
16 weeks
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