Table_1_The Need for Structured Strategies to Improve Stroke Care in a Rural Telestroke Network in Northern New South Wales, Australia: An Observational Study.PDF

Introduction: A telestroke network in Northern New South Wales, Australia has been developed since 2017. We theorized that the telestroke network development would drive a progressive improvement in stroke care metrics over time.
Aim: This study aimed to describe changes in acute stroke workflow metrics over time to determine whether they improved with network experience.
Methods: We prospectively collected data of patients assessed by telestroke who received multimodal computed tomography (mCT) and were diagnosed with ischemic stroke or transient ischemic attack from January 2017 to July 2019. The period was divided into two phases (phase 1: January 2017 – October 2018 and phase 2: November 2018 – July 2019). We compared median door-to-call, door-to-image, and door-to-decision time between the two phases.
Results: We included 433 patients (243 in phase 1 and 190 in phase 2). Each spoke site treated 1.5–5.2 patients per month. There were Door-to-call time (median 39 in phase 1, 35 min in phase 2, p = 0.18), and door-to-decision time (median 81.5 vs. 83 min, p = 0.31) were not improved significantly. Similarly, in the reperfusion therapy subgroup, door-to-call time (median 29 vs. 24.5 min, p = 0.12) and door-to-decision time (median 70.5 vs. 67.5 min, p = 0.75) remained substantially unchanged. Regression analysis showed no association between time in the network and door-to-decision time (coefficient 1.5, p = 0.32).
Conclusion: In our telestroke network, acute stroke timing metrics did not improve over time. There is the need for targeted education and training focusing on both stroke reperfusion competencies and the technical aspects of telestroke in areas with limited workforce and high turnover.

引言：澳大利亚新南威尔士州北部的远程卒中（telestroke）网络自2017年起启动建设。我们提出研究假设：远程卒中网络的持续发展将随时间推移推动卒中救治指标的逐步改善。
研究目的：本研究旨在描述急性卒中救治流程指标随时间的变化情况，以明确该网络的临床经验积累是否能带来救治指标的优化。
研究方法：我们前瞻性收集了2017年1月至2019年7月期间，经远程卒中评估、接受多模态计算机断层扫描（multimodal computed tomography, mCT）并被诊断为缺血性卒中或短暂性脑缺血发作（transient ischemic attack）的患者数据。将研究周期划分为两个阶段（阶段1：2017年1月—2018年10月；阶段2：2018年11月—2019年7月），对比两个阶段的中位入院至呼叫时间、入院至影像检查时间以及入院至决策时间。
研究结果：本研究共纳入433例患者（阶段1 243例，阶段2 190例）。各远程接诊站点每月收治患者1.5~5.2例。结果显示，入院至呼叫时间（阶段1中位值39 min，阶段2中位值35 min，p=0.18）与入院至决策时间（阶段1中位值81.5 min vs 阶段2 83 min，p=0.31）均未出现显著改善。同样，在再灌注治疗亚组中，入院至呼叫时间（中位值29 min vs 24.5 min，p=0.12）与入院至决策时间（中位值70.5 min vs 67.5 min，p=0.75）亦无明显变化。回归分析显示，网络驻留时长与入院至决策时间无显著关联（系数1.5，p=0.32）。
研究结论：在本远程卒中网络中，急性卒中救治的时间相关指标并未随时间推移得到改善。对于人力资源有限且人员流动率较高的地区，亟需开展针对性的教育培训，内容涵盖卒中再灌注救治能力与远程卒中操作技术两大方面。