溶栓成像到针时间是比较远程医疗与现场评估急性缺血性卒中的度量。

IF 1.1 4区 医学 Q4 CLINICAL NEUROLOGY
Andrea Loggini, Faddi G Saleh Velez, Jessie Henson, Julie Wesler, Jonatan Hornik, Amber Schwertnam, Karam Dallow, Joaquin Grimaldi, Alejandro Hornik
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引用次数: 0

摘要

目的:门到针时间(DTN)是衡量急性缺血性卒中溶栓给药效率的标准,并有指南推荐DTN方法:这是一项回顾性队列研究,研究对象是南伊利诺斯州卫生保健中心接受溶栓治疗的卒中患者。回顾了1个月的人口统计学、临床表现、卒中指标、溶栓并发症和mRS数据。采用多变量logistic回归模型评估DTN、ITN和DIT的预测因子,OR和95% CI。p值设为0.05。结果:287例患者中,170例采用远程医疗评估,117例现场评估。两组在人口统计学和中风严重程度上具有可比性。远程医疗的中位DTN更长,以分钟为单位[55 (43 - 70)vs. 42(34 - 62)]。结论:ITN是比较远程医疗和现场评估比DTN更准确的指标,因为它排除了DTN固有的中风特异性护理过程和患者特异性因素,与评估方式无关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Thrombolytic Imaging-to-Needle Time as a Metric for Comparing Telemedicine versus In-Person Evaluation in Acute Ischemic Stroke.

Objectives: Door-to-needle time (DTN) is standard for measuring the efficiency of thrombolytic administration in acute ischemic stroke, with guidelines recommending DTN <60 minutes. DTN can be divided into door-to-imaging time (DIT) and imaging-to-needle time (ITN), separated by arrival at the CT scanner. We hypothesize that ITN is more accurate for comparing the mode of evaluation for stroke patients treated with thrombolytics.

Methods: This is a retrospective cohort study of stroke patients treated with thrombolytics at Southern Illinois Health care. Data on demographics, clinical presentation, stroke metrics, thrombolytic complications, and mRS at 1-month were reviewed. Multivariate logistic regression models were applied to evaluate predictors of DTN, ITN, and DIT, with OR and 95% CI. P-value was set at 0.05.

Results: Out of 287 patients, 170 were evaluated by telemedicine, 117 in-person. The 2 groups were comparable in demographics and stroke severity. Telemedicine had longer median DTN, in minutes [55 (43 to 70) vs. 42 (34 to 62), P<0.01], and median ITN, in minutes [43 (35-58) vs. 32 (25-48), P<0.01]. There was no statistical difference in DIT between the 2 groups. Adjusted for stroke severity and age, telemedicine was associated with lower odds of DTN <60 minutes (OR: 0.553, 95% CI: 0.328-0.931, P=0.026) and ITN <35 minutes (OR: 0.265, 95% CI: 0.159-0.441, P<0.01). However, telemedicine was not independently associated with DIT <25 minutes, which was instead inversely correlated with age (OR: 0.974, 95% CI: 0.951-0.997, P=0.03).

Conclusions: ITN represents a more accurate metric for comparing telemedicine and in-person evaluations than DTN, as it excludes stroke-specific processes of care and patient-specific factors that are intrinsic to DTN and unrelated to the modality of evaluation.

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来源期刊
Neurologist
Neurologist 医学-临床神经学
CiteScore
1.90
自引率
0.00%
发文量
151
审稿时长
2 months
期刊介绍: The Neurologist publishes articles on topics of current interest to physicians treating patients with neurological diseases. The core of the journal is review articles focusing on clinically relevant issues. The journal also publishes case reports or case series which review the literature and put observations in perspective, as well as letters to the editor. Special features include the popular "10 Most Commonly Asked Questions" and the "Patient and Family Fact Sheet," a handy tear-out page that can be copied to hand out to patients and their caregivers.
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