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Kim J, Olaiya MT, De Silva DA, Norrving B, Bosch J, De Sousa DA, Christensen HK, Ranta A, Donnan GA, Feigin V, Martins S, Schwamm LH, Werring DJ, Howard G, Owolabi M, Pandian J, Mikulik R, Thayabaranathan T, Cadilhac DA. Global stroke statistics 2023: Availability of reperfusion services around the world. Int J Stroke 2024; 19:253-270. [PMID: 37853529 PMCID: PMC10903148 DOI: 10.1177/17474930231210448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Disparities in the availability of reperfusion services for acute ischemic stroke are considerable globally and require urgent attention. Contemporary data on the availability of reperfusion services in different countries are used to provide the necessary evidence to prioritize where access to acute stroke treatment is needed. AIMS To provide a snapshot of published literature on the provision of reperfusion services globally, including when facilitated by telemedicine or mobile stroke unit services. METHODS We searched PubMed to identify original articles, published up to January 2023 for the most recent, representative, and relevant patient-level data for each country. Keywords included thrombolysis, endovascular thrombectomy and telemedicine. We also screened reference lists of review articles, citation history of articles, and the gray literature. The information is provided as a narrative summary. RESULTS Of 11,222 potentially eligible articles retrieved, 148 were included for review following de-duplications and full-text review. Data were also obtained from national stroke clinical registry reports, Registry of Stroke Care Quality (RES-Q) and PRE-hospital Stroke Treatment Organization (PRESTO) repositories, and other national sources. Overall, we found evidence of the provision of intravenous thrombolysis services in 70 countries (63% high-income countries (HICs)) and endovascular thrombectomy services in 33 countries (68% HICs), corresponding to far less than half of the countries in the world. Recent data (from 2019 or later) were lacking for 35 of 67 countries with known year of data (52%). We found published data on 74 different stroke telemedicine programs (93% in HICs) and 14 active mobile stroke unit pre-hospital ambulance services (80% in HICs) around the world. CONCLUSION Despite remarkable advancements in reperfusion therapies for stroke, it is evident from available patient-level data that their availability remains unevenly distributed globally. Contemporary published data on availability of reperfusion services remain scarce, even in HICs, thereby making it difficult to reliably ascertain current gaps in the provision of this vital acute stroke treatment around the world.
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Affiliation(s)
- Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Deidre A De Silva
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jackie Bosch
- School of Rehabilitation Science, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Diana A De Sousa
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Hanne K Christensen
- Department of Neurology, University of Copenhagen and Bispebjerg Hospital, Copenhagen, Denmark
| | - Anna Ranta
- Department of Medicine, University of Otago, Wellington, Wellington, New Zealand
| | - Geoffrey A Donnan
- Melbourne Brain Centre, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Sheila Martins
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - George Howard
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Robert Mikulik
- Health Management Institute, Brno, Czech Republic
- Neurology Department, Bata Hospital, Zlin, Czech Republic
| | - Tharshanah Thayabaranathan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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Gallerini S, Marsili L, Groccia V, Bartalucci M, Innocenti E, Marotti C, Pieri S, Plewnia K, Scarpini C, Keeling EG, Gregorio M, Geraci S, Zocchi M, Cirinei M, De Stefano T, Galassi S, Martini G, Tassi R, Bracco S, Cerase A, Dami S, Panzardi G, Breggia M, Marconi R. Appropriateness, safety, and effectiveness of “drip and ship” teleconsultation model in Southeastern Tuscany: a feasibility study. Neurol Sci 2020; 41:2961-2965. [DOI: 10.1007/s10072-020-04446-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/25/2020] [Indexed: 11/24/2022]
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Ohannessian R, Schott AM, Colin C, Nighoghossian N, Medeiros de Bustos E, Moulin T. Acute telestroke in France: A systematic review. Rev Neurol (Paris) 2020; 176:316-324. [PMID: 32147201 DOI: 10.1016/j.neurol.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/12/2019] [Accepted: 11/18/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Acute telestroke is the use of telemedicine to improve acute stroke care. It has demonstrated to be a safe and effective medical practice. Since 2011, acute telestroke has been promoted by the Ministry of Health in France, and in 2018 many regions were in the process or completion of implementing telestroke. The objective of this study was to describe acute telestroke implementation in France. METHODS A systematic review was conducted using PubMed and ScienceDirect databases. Articles and abstracts in English and French, published between January 1st, 2000 to April 30th, 2018 were used. Studies conducted in France and that had presented an outcome evaluation of a regional acute telestroke activity were included. No meta-analysis was conducted. RESULTS A total of 24 studies (14 in French, 10 in English) were included, with 13 published articles (7 indexed on PubMed) and 11 abstracts. Among the 13 published articles, there were seven observational retrospective studies, one quasi-experimental before-after study, one experimental randomised controlled trial, and four medico-economic studies. All telestroke network models of care were drip-and-ship with hub and spoke organisation. The case-control studies did not show a difference with or without telemedicine. The territorial thrombolysis rate was measured in two regions, with an increase in Franche-Comté from 0.2% (2004) to 9.9% (2015), and a relative increase of 76% in Nord-Pas-de-Calais between 2009-2010 and 2012. CONCLUSION Implementation of acute telestroke in France had a positive clinical and public health impact but the evaluation remained limited and needs to be supported.
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Affiliation(s)
- R Ohannessian
- CIC-1431 Inserm département de Neurologie, EA 481 laboratoire de neurosciences intégratives et cliniques université de Franche-Comté, UBFC, CHRU de Besançon, Besançon, France; Télémédecine 360, TLM360, Paris, France.
| | - A-M Schott
- HESPER EA 7425, université Lyon, université Claude Bernard Lyon 1, 69008 Lyon, France; Pôle IMER, hospices civils de Lyon, 69003 Lyon, France
| | - C Colin
- HESPER EA 7425, université Lyon, université Claude Bernard Lyon 1, 69008 Lyon, France; Pôle IMER, hospices civils de Lyon, 69003 Lyon, France
| | - N Nighoghossian
- Unité neurovasculaire, hôpital Pierre-Wertheimer, hospices Civils de Lyon, 69677 Bron cedex, France
| | | | - T Moulin
- Department of Neurology, University Hospital of Besançon, Besançon, France; French Society of Telemedicine, Paris, France
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Pruvo JP, Berge J, Kuchcinski G, Bretzner M, Leclerc X, Hacein-Bey L. Health Care Organization for the Management of Stroke. Neuroimaging Clin N Am 2018; 28:691-698. [DOI: 10.1016/j.nic.2018.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Porter J, Hall RE, Kapral MK, Fang J, Khan F, Silver FL. Outcomes following telestroke-assisted thrombolysis for stroke in Ontario, Canada. J Telemed Telecare 2017; 24:492-499. [PMID: 28691864 DOI: 10.1177/1357633x17717601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Since 2002, the Ontario Telestroke Program has provided hospitals in under-served regions of the province the opportunity to offer intravenous thrombolysis with tissue plasminogen activator (IV tPA) to eligible patients. The purpose of this study was to determine whether telestroke-assisted IV tPA patients had similar risks of 7- and 90-day mortality, symptomatic intracerebral haemorrhage (sICH), and poor functional outcome compared to patients who received IV tPA with on-site expertise. Methods Data from two audits of patients with acute ischaemic stroke hospitalized in Ontario, Canada in 2010 and 2012 were analysed. We modelled the risk of all-cause death within 7 and 90 days of receiving IV tPA using proportional hazards adjusting for hospital type, patient characteristics, and whether IV tPA was administered as part of a telestroke consultation. Outcomes of sICH and modified Rankin Scale ≥ 3 at discharge were modelled using generalized estimating equations adjusting for the same variables used in the mortality model. Results There was no difference in 7- or 90-day mortality among those who received IV tPA with telestroke ( n = 214) compared to those without ( n = 1885) (7-day adjusted hazard ratio (aHR) 1.29 (95% confidence interval (CI) 0.68, 2.44); 90-day aHR 1.01 (95% CI 0.67, 1.50)). Complications were similar between groups, with an adjusted odds ratio (aOR) for sICH of 0.71 (95% CI 0.29, 1.71) and an aOR of 0.75 (95% CI 0.46, 1.23) for poor functional ability at discharge. Discussion Patients receiving IV tPA supported by telestroke had similar outcomes to those managed with on-site expertise.
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Affiliation(s)
- Joan Porter
- 1 Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Ruth E Hall
- 1 Institute for Clinical Evaluative Sciences, Toronto, Canada.,2 Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,3 Ontario Stroke Network, Toronto, Canada
| | - Moira K Kapral
- 1 Institute for Clinical Evaluative Sciences, Toronto, Canada.,2 Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,4 Department of Medicine, University of Toronto, Toronto, Canada.,5 Division of General Medicine and Toronto General Research Institute, University Health Network, Toronto, Canada
| | - Jiming Fang
- 1 Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Ferhana Khan
- 1 Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Frank L Silver
- 1 Institute for Clinical Evaluative Sciences, Toronto, Canada.,4 Department of Medicine, University of Toronto, Toronto, Canada.,6 Krembil Neuroscience Program, University Health Network, Toronto, Canada
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De Luca R, Bramanti A, De Cola MC, Trifiletti A, Tomasello P, Torrisi M, Reitano S, Leo A, Bramanti P, Calabrò RS. Tele-health-care in the elderly living in nursing home: the first Sicilian multimodal approach. Aging Clin Exp Res 2016; 28:753-9. [PMID: 26420423 DOI: 10.1007/s40520-015-0463-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/22/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND The continued aging of the population is affecting the health of the industrialized countries, with an increasing burden for the healthcare system. Thus, during the last decade, we assisted to relevant progress in the medical treatment and rehabilitation techniques and devices, including the development of telemedicine for geriatric care. AIM To demonstrate the effectiveness of a novel tele-health-care model allowing a better management of elderly living in nursing homes. METHODS Fifty-nine elderly patients (19 males and 40 females; mean age 79.1 (±9.2), were randomly divided into two groups: the experimental group that performed a proper telemonitoring with a multimodal approach (including monitoring of the vital signs and neurological/psychological counseling), and the control group, which underwent standard in-home nursing care. Neurobehavioral symptoms and quality of life were assessed in both the groups at baseline, and after the telecare protocol's end. RESULTS The experimental group had a statistically significant reduction in Geriatric Depression Scale (p < 0.01) and Brief Psychiatric Rating Scale (p < 0.05) scores, and an improvement in their quality of life. Moreover, mean blood pressure and heart rate were lower in the experimental than in the control group (p < 0.05), and admission to health care services was higher in the control than in the experimental group (p < 0.05). CONCLUSIONS Telemedicine can be considered as an important tool in improving health and quality of life in the elderly living in nursing homes, and potentially reducing healthcare service access, hospitalization, and costs.
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Affiliation(s)
- Rosaria De Luca
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Alessia Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Maria Cristina De Cola
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Antonino Trifiletti
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Provvidenza Tomasello
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Michele Torrisi
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Simone Reitano
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Antonino Leo
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
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Richard S, Mione G, Varoqui C, Vezain A, Brunner A, Bracard S, Debouverie M, Braun M. Simulation training for emergency teams to manage acute ischemic stroke by telemedicine. Medicine (Baltimore) 2016; 95:e3924. [PMID: 27311003 PMCID: PMC4998489 DOI: 10.1097/md.0000000000003924] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Telemedicine contributes to initiating early intravenous recombinant tissue plasminogen activator (rt-PA) treatment for patients with acute cerebral infarction in areas without a stroke unit. However, the experience and skills of the emergency teams in the spokes to prepare patients and administer rt-PA treatment are ill-defined. Improving these skills could vastly improve management of acute stroke by telemedicine. We developed a medical simulation training model for emergency teams to perform intravenous rt-PA treatment in a telestroke system.From February 2013 to May 2015, 225 learners from 6 emergency teams included in the telestroke system "Virtuall"-in Lorrain (northeastern France)-received a standardized medical simulation training module to perform rt-PA treatment. All learners were assessed with the same pretraining and posttraining test consisting of 52 items. The percentage of right answers was determined for every learner before and after training.Median percentages of right answers were significantly higher in the posttraining test overall (82 ± 10 vs. 59 ± 13% pretraining; P < 0.001), but also in all professional subgroups: physicians (88 ± 8 vs. 67 ± 12%; P < 0.001), paramedical staff (80 ± 9 vs. 54 ± 12%; P < 0.001), nurses (80 ± 8 vs. 54 ± 12%; P < 0.001), and auxiliary nurses (76 ± 17 vs. 37 ± 15%; P = 0.002).We describe for the first time a training model for emergency teams in a telestroke system. We demonstrate significant gain in knowledge for all groups of healthcare professionals. This simulation model could be applied in any medical simulation center and form the basis of a standardized training program of spokes in a telestroke system.
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Affiliation(s)
- Sébastien Richard
- Department of Neurology, Stroke Unit, University Hospital of Nancy
- Centre Universitaire d’Enseignement et de Simulation Médicale, Faculty of Medicine of Nancy
- Centre d’Investigation Clinique Plurithématique Pierre Drouin, University Hospital of Nancy
| | - Gioia Mione
- Department of Neurology, Stroke Unit, University Hospital of Nancy
| | - Claude Varoqui
- Centre Universitaire d’Enseignement et de Simulation Médicale, Faculty of Medicine of Nancy
| | | | | | - Serge Bracard
- Department of Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Marc Debouverie
- Department of Neurology, Stroke Unit, University Hospital of Nancy
| | - Marc Braun
- Centre Universitaire d’Enseignement et de Simulation Médicale, Faculty of Medicine of Nancy
- Department of Neuroradiology, University Hospital of Nancy, Nancy, France
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A one-to-one telestroke network: the first Italian study of a web-based telemedicine system for thrombolysis delivery and patient monitoring. Neurol Sci 2016; 37:725-30. [DOI: 10.1007/s10072-016-2569-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 03/22/2016] [Indexed: 11/25/2022]
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Raulot L, Mione G, Hoffmann C, Bracard S, Braun M, Brunner A, Vezain A, Langard S, Lesage F, Durupt L, Richard S. Intravenous thrombolytic therapy for ischemic stroke via telemedicine compared with bedside treatment in an experienced stroke unit. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.eurtel.2015.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Amadi-Obi A, Gilligan P, Owens N, O'Donnell C. Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment. Int J Emerg Med 2014; 7:29. [PMID: 25635190 PMCID: PMC4306051 DOI: 10.1186/s12245-014-0029-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/19/2014] [Indexed: 12/22/2022] Open
Abstract
The right person in the right place and at the right time is not always possible; telemedicine offers the potential to give audio and visual access to the appropriate clinician for patients. Advances in information and communication technology (ICT) in the area of video-to-video communication have led to growth in telemedicine applications in recent years. For these advances to be properly integrated into healthcare delivery, a regulatory framework, supported by definitive high-quality research, should be developed. Telemedicine is well suited to extending the reach of specialist services particularly in the pre-hospital care of acute emergencies where treatment delays may affect clinical outcome. The exponential growth in research and development in telemedicine has led to improvements in clinical outcomes in emergency medical care. This review is part of the LiveCity project to examine the history and existing applications of telemedicine in the pre-hospital environment. A search of electronic databases including Medline, Excerpta Medica Database (EMBASE), Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant papers was performed. All studies addressing the use of telemedicine in emergency medical or pre-hospital care setting were included. Out of a total of 1,279 articles reviewed, 39 met the inclusion criteria and were critically analysed. A majority of the studies were on stroke management. The studies suggested that overall, telemedicine had a positive impact on emergency medical care. It improved the pre-hospital diagnosis of stroke and myocardial infarction and enhanced the supervision of delivery of tissue thromboplasminogen activator in acute ischaemic stroke. Telemedicine presents an opportunity to enhance patient management. There are as yet few definitive studies that have demonstrated whether it had an effect on clinical outcome.
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Affiliation(s)
- Ahjoku Amadi-Obi
- Clinical Research Department, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland ; Emergency Department, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Peadar Gilligan
- Emergency Department, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Niall Owens
- School of Medicine, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Cathal O'Donnell
- National Ambulance Services, Oak House, Millennium Park, Naas, County Kildare, Ireland
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