BACKGROUND Administration of thrombolytics for acute ischemic stroke(AIS)via telemedicine has expanded in recent years at institutions without on-site neurology specialists.This helped to improve the care of stroke pa...BACKGROUND Administration of thrombolytics for acute ischemic stroke(AIS)via telemedicine has expanded in recent years at institutions without on-site neurology specialists.This helped to improve the care of stroke patients in rural areas.However,it is uncertain if telemedicine-administered thrombolytics is as safe and effective as inperson evaluation by neurology specialists.AIM The authors conducted a meta-analysis evaluating stroke metrics,safety and outcomes of telemedicine compared to in-person evaluation by neurologist specialist in AIS patients receiving intravenous thrombolytics.METHODS PubMed,EMBASE,and Cochrane were searched for randomized clinical trials and observational cohort studies.The Mantel-Haenszel method or inverse variance,as applicable,were applied to calculate an overall effect estimate for each outcome by combining specific risk ratio(RR)or standardized mean difference(SMD).Risk of bias was analyzed using the Newcastle-Ottawa Scale.Primary outcome examined was door-to-needle time(DTN).Secondary outcomes were symptomatic intracranial hemorrhage(sICH),mortality,and mRS≤2.RESULTS Eleven retrospective cohort studies involving 2350 patients were included in the analysis.Of those,34%(n=794)received thrombolytics via telemedicine.Telemedicine was associated with a significantly longer mean DTN compared to inperson evaluation[SMD:0.72 minutes;95%confidence interval(CI)0.22-1.22;P<0.01],a similar rate of sICH[3.9%vs 4.2%;Odds ratio(OR):0.75;95%CI 0.42-1.37;P=0.35],similar rate of mortality(13.2%vs 14.7%;OR:0.87;95%CI 0.47-1.63;P=0.67),and comparable rate of favorable short-term functional outcome(46.8%vs 50.7%;OR:0.79;95%CI 0.41-1.53;P=0.48).Risk of bias was low to moderate for each outcome.CONCLUSION The available literature suggests that telemedicine is associated with longer DTN compared to in-person evaluation.This difference in stroke metric does not affect safety or outcome.Further studies are needed to understand and address the underlying factors of the longer DTN time.展开更多
文摘BACKGROUND Administration of thrombolytics for acute ischemic stroke(AIS)via telemedicine has expanded in recent years at institutions without on-site neurology specialists.This helped to improve the care of stroke patients in rural areas.However,it is uncertain if telemedicine-administered thrombolytics is as safe and effective as inperson evaluation by neurology specialists.AIM The authors conducted a meta-analysis evaluating stroke metrics,safety and outcomes of telemedicine compared to in-person evaluation by neurologist specialist in AIS patients receiving intravenous thrombolytics.METHODS PubMed,EMBASE,and Cochrane were searched for randomized clinical trials and observational cohort studies.The Mantel-Haenszel method or inverse variance,as applicable,were applied to calculate an overall effect estimate for each outcome by combining specific risk ratio(RR)or standardized mean difference(SMD).Risk of bias was analyzed using the Newcastle-Ottawa Scale.Primary outcome examined was door-to-needle time(DTN).Secondary outcomes were symptomatic intracranial hemorrhage(sICH),mortality,and mRS≤2.RESULTS Eleven retrospective cohort studies involving 2350 patients were included in the analysis.Of those,34%(n=794)received thrombolytics via telemedicine.Telemedicine was associated with a significantly longer mean DTN compared to inperson evaluation[SMD:0.72 minutes;95%confidence interval(CI)0.22-1.22;P<0.01],a similar rate of sICH[3.9%vs 4.2%;Odds ratio(OR):0.75;95%CI 0.42-1.37;P=0.35],similar rate of mortality(13.2%vs 14.7%;OR:0.87;95%CI 0.47-1.63;P=0.67),and comparable rate of favorable short-term functional outcome(46.8%vs 50.7%;OR:0.79;95%CI 0.41-1.53;P=0.48).Risk of bias was low to moderate for each outcome.CONCLUSION The available literature suggests that telemedicine is associated with longer DTN compared to in-person evaluation.This difference in stroke metric does not affect safety or outcome.Further studies are needed to understand and address the underlying factors of the longer DTN time.
