Telestroke Consultation in the Emergency Medical Services Unit: A Novel Approach to Improve Thrombolysis Times.
Aged
Aged, 80 and over
Clinical Decision-Making
Emergency Medical Services
Endovascular Procedures
/ adverse effects
Feasibility Studies
Female
Fibrinolytic Agents
/ administration & dosage
Humans
Infusions, Intravenous
Male
Middle Aged
Pilot Projects
Prospective Studies
Remote Consultation
Stroke
/ diagnosis
Thrombectomy
/ adverse effects
Thrombolytic Therapy
/ adverse effects
Time Factors
Time-to-Treatment
Tissue Plasminogen Activator
/ administration & dosage
Transportation of Patients
Treatment Outcome
Triage
Videoconferencing
EMS
Endovascular therapy
Prehospital triage
Telestroke
thrombolysis
Journal
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
ISSN: 1532-8511
Titre abrégé: J Stroke Cerebrovasc Dis
Pays: United States
ID NLM: 9111633
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
received:
09
12
2020
revised:
07
02
2021
accepted:
18
02
2021
pubmed:
11
3
2021
medline:
29
4
2021
entrez:
10
3
2021
Statut:
ppublish
Résumé
Faster treatment times are associated with improved outcomes in patients with acute ischemic stroke. In this prospective pilot study, we assess the feasibility of initiating telestroke consultation in emergency medical services unit (TEMS). Patients with stroke symptoms were evaluated via TEMS using a video-call with a stroke provider. After TEMS evaluation, patients were transferred to the nearest stroke center (NSC) or thrombectomy capable center (TCS) depending on stroke severity and symptom onset time. We compared time metrics between patients evaluated via TEMS to those via standard telestroke (STS) consultation. 49 patients were evaluated via TEMS between May 2017 and March 2020. Median age was 66, 24 (49%) were females, 15 (30.6%) received intravenous alteplase (tPA) after arrival to a local hospital, and 3 (6.1%) underwent mechanical thrombectomy (MT) after bypassing the NSC. Compared to 52 tPA patients treated through STS consultation, TEMS patients had shorter door to needle (DTN) time (21 vs. 38 min, p < 0.001). In addition, patients who received MT after bypassing the NSC had shorter onset to groin time compared to those transferred from NSC (216 vs. 293 min, P = 0.04). Prehospital stroke triaging using TEMS is feasible, and could result in shorter DTN and onset to groin times.
Sections du résumé
BACKGROUND
BACKGROUND
Faster treatment times are associated with improved outcomes in patients with acute ischemic stroke. In this prospective pilot study, we assess the feasibility of initiating telestroke consultation in emergency medical services unit (TEMS).
METHODS
METHODS
Patients with stroke symptoms were evaluated via TEMS using a video-call with a stroke provider. After TEMS evaluation, patients were transferred to the nearest stroke center (NSC) or thrombectomy capable center (TCS) depending on stroke severity and symptom onset time. We compared time metrics between patients evaluated via TEMS to those via standard telestroke (STS) consultation.
RESULTS
RESULTS
49 patients were evaluated via TEMS between May 2017 and March 2020. Median age was 66, 24 (49%) were females, 15 (30.6%) received intravenous alteplase (tPA) after arrival to a local hospital, and 3 (6.1%) underwent mechanical thrombectomy (MT) after bypassing the NSC. Compared to 52 tPA patients treated through STS consultation, TEMS patients had shorter door to needle (DTN) time (21 vs. 38 min, p < 0.001). In addition, patients who received MT after bypassing the NSC had shorter onset to groin time compared to those transferred from NSC (216 vs. 293 min, P = 0.04).
CONCLUSION
CONCLUSIONS
Prehospital stroke triaging using TEMS is feasible, and could result in shorter DTN and onset to groin times.
Identifiants
pubmed: 33690029
pii: S1052-3057(21)00113-0
doi: 10.1016/j.jstrokecerebrovasdis.2021.105710
pii:
doi:
Substances chimiques
Fibrinolytic Agents
0
Tissue Plasminogen Activator
EC 3.4.21.68
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
105710Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest SA: reports no conflict of interest, EA: reports no conflict of interest, CG: reports no conflict of interest, DH: reports no conflict of interest, JH: reports no conflict of interest, MB: reports no conflict of interest, PS: reports no conflict of interest, DJ: reports no conflict of interest, CAH: reports no conflict of interest.