Effects of Telestroke on Thrombolysis Times and Outcomes: A Meta-analysis

Objective: Telestroke systems are tools, used to provide an advanced stroke care in regions without sufficient neurologic services. We performed this meta-analysis to assess the effects of telemedicine on treatment times and clinical outcomes of acute stroke care. Methods: A literature search of PubMed, SCOPUS, and Cochrane CENTRAL was conducted for original studies investigating telemedicine applications in acute stroke care. Dichotomous data on treatment outcomes were pooled as odds ratios (ORs), while continuous data on thrombolysis times were pooled as mean differences (MDs) with 95% confidence interval (CI), using RevMan software (version 5.3). Results: Pooling data from 26 studies (6605 thrombolysed patients) showed no significant differences between the telestroke and control groups in terms of in-hospital mortality (OR = 1.21, 95% CI [0.98, 1.49]), 90-day mortality (OR = 1.08, 95% CI [0.85, 1.37]), symptomatic intracranial hemorrhage (sICH) (OR = 1.10, 95% CI [0.79, 1.53]), and favorable clinical outcome at discharge (OR = 1.03, 95% CI [0.69, 1.53]) and 90 days later (OR = 0.99, 95% CI [0.82, 1.18]). The onset-to-door (OTD) duration (MD = −10.4 minutes, 95% CI [−14.79, −.01]) and length of hospital stay (MD = −0.55 days, 95% CI [−1.02, −0.07]) were significantly shorter in the telestroke group, compared to the control group. Although the overall effect estimate (under the fixed-effect model) showed a significant decrease in the onset-to-treatment (OTT) duration in the telestroke group (MD = −5.83 minutes, 95% CI [−8.57, −3.09]), employing the random-effects model for between-study heterogeneity abolished this significance (MD = −5.90 minutes, 95% CI [−13.23, 1.42]). Conclusion: Telestroke significantly reduced OTD and hospital stay durations in stroke patients without increasing the risk of mortality or sICH. Therefore, telemedicine can improve stroke care in regional areas with minor experience in thrombolysis. Further randomized controlled trials are needed to assess the benefits of telestroke systems, especially in terms of cost-effectiveness and quality of life outcomes.

研究目的：远程卒中系统（telestroke）是用于在神经科服务资源不足地区开展高级卒中救治的工具。本研究开展此项荟萃分析，旨在评估远程医疗对急性卒中救治的治疗时长与临床结局的影响。
研究方法：本研究对PubMed、Scopus及考克兰中央临床试验注册库（Cochrane CENTRAL）进行文献检索，纳入探究远程医疗在急性卒中救治中应用的原始研究。采用RevMan软件（版本5.3）完成数据合并：治疗结局的二分类数据以比值比（odds ratios, OR）合并，溶栓时间的连续性数据以均数差（mean differences, MD）结合95%置信区间（confidence interval, CI）合并。
研究结果：对26项研究（共6605例接受溶栓治疗的患者）的数据进行合并分析显示，远程卒中组与对照组在住院期间死亡率（OR=1.21，95%CI [0.98, 1.49]）、发病后90天死亡率（OR=1.08，95%CI [0.85, 1.37]）、症状性颅内出血（symptomatic intracranial hemorrhage, sICH）（OR=1.10，95%CI [0.79, 1.53]）、出院时良好临床结局（OR=1.03，95%CI [0.69, 1.53]）及发病后90天良好临床结局（OR=0.99，95%CI [0.82, 1.18]）方面均无显著统计学差异。与对照组相比，远程卒中组的发病到入院时间（onset-to-door, OTD）（MD=-10.4分钟，95%CI [-14.79, -0.01]）与住院时长（MD=-0.55天，95%CI [-1.02, -0.07]）均显著缩短。尽管固定效应模型下的总体效应估计显示，远程卒中组的发病到治疗时间（onset-to-treatment, OTT）显著缩短（MD=-5.83分钟，95%CI [-8.57, -3.09]），但针对研究间异质性采用随机效应模型后，该差异不再具有统计学意义（MD=-5.90分钟，95%CI [-13.23, 1.42]）。
研究结论：远程卒中系统可显著缩短卒中患者的发病到入院时间与住院时长，且未增加患者的死亡或症状性颅内出血风险。因此，远程医疗可改善溶栓经验不足的区域卒中救治水平。未来仍需开展更多随机对照试验，以评估远程卒中系统的获益，尤其是在成本效益与生活质量结局方面。