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Chung I, Bae HJ, Kim BJ, Kim JY, Han MK, Kim J, Jung C, Kang J. Interactive Direct Interhospital Transfer Network System for Acute Stroke in South Korea. J Clin Neurol 2023; 19:125-130. [PMID: 36647229 PMCID: PMC9982181 DOI: 10.3988/jcn.2022.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/30/2022] [Accepted: 07/30/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND PURPOSE Interhospital transfer is an essential practical component of regional stroke care systems. To establish an effective stroke transfer network in South Korea, an interactive transfer system was constructed, and its workflow metrics were observed. METHODS In March 2019, a direct transfer system between primary stroke hospitals (PSHs) and comprehensive regional stroke centers (CSCs) was established to standardize the clinical pathway of imaging, recanalization therapy, transfer decisions, and exclusive transfer linkage systems in the two types of centers. In an active case, the time metrics from arrival at PSH ("door") to imaging was measured, and intravenous thrombolysis (IVT) and endovascular treatment (EVT) were used to assess the differences in clinical situations. RESULTS The direct transfer system was used by 27 patients. They stayed at the PSH for a median duration of 72 min (interquartile range [IQR], 38-114 min), with a median times of 15 and 58 min for imaging and subsequent processing, respectively. The door-to-needle median times of subjects treated with IVT at PSHs (n=5) and CSCs (n=2) were 21 min (IQR, 20.0-22.0 min) and 137.5 min (IQR, 125.3-149.8 min), respectively. EVT was performed on seven subjects (25.9%) at CSCs, which took a median duration of 175 min; 77 min at the PSH, 48 min for transportation, and 50 min at the CSC. Before EVT, bridging IVT at the PSH did not significantly affect the door-to-puncture time (127 min vs. 143.5 min, p=0.86). CONCLUSIONS The direct and interactive transfer system is feasible in real-world practice in South Korea and presents merits in reducing the treatment delay by sharing information during transfer.
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Affiliation(s)
- Inyoung Chung
- Department of Neurology, H PLUS YANGJI Hospital, Seoul, Korea.,Department of Neurology, Gyeonggi Provincial Medical Center Icheon Hospital, Icheon, Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea
| | - Jun Yup Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea
| | - Jinhwi Kim
- Department of Emergency Medicine, Gyeonggi Provincial Medical Center Icheon Hospital, Icheon, Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jihoon Kang
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Korea.
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2
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Turner AC, Etherton MR. Utilization of Telestroke Prior to and Following the COVID-19 Pandemic. Semin Neurol 2022; 42:3-11. [PMID: 35576926 DOI: 10.1055/s-0041-1742181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For over two decades, telestroke has been utilized as a means for improving acute access to a stroke specialist when this expertise is otherwise unavailable. During this time, telestroke use has increased and improvements in care metrics have been widely reported. Several telestroke model variations are utilized; each has different workflow implications. A successful telestroke system should include adequate protocols and training, equipment, documentation system, and tracking of quality metrics. Upfront costs of needed technology and devices, credentialing hurdles, and limited reimbursement are all reported barriers to the utilization of telestroke. Emphasis on safety measures during the COVID-19 pandemic resulted in the dramatic upscaling of telehealth utilization, although overall stroke volumes declined in many areas in the early phases of the pandemic. Going forward, continued reduction in cost of required devices and broadband connections, increased use of automated and advanced analytical software, and a universal licensing and credentialing system are needed to continue the expansion of telestroke use.
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Affiliation(s)
- Ashby C Turner
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark R Etherton
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Lyerly MJ, Daggy J, LaPradd M, Martin H, Edwards B, Graham G, Martini S, Anderson J, Williams LS. Impact of Telestroke Implementation on Emergency Department Transfer Rate. Neurology 2022; 98:e1617-e1625. [PMID: 35228338 DOI: 10.1212/wnl.0000000000200143] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND and Purpose: Telestroke networks are associated with improved outcomes from acute ischemic stroke(AIS) patient and facilitate greater access to care, particularly in underserved regions. These networks also have the potential to influence patient disposition through avoiding unnecessary interhospital transfers. This study examines the impact of implementation of the VA National Telestroke Program (NTSP) on interhospital transfer among Veterans. METHODS We analyzed AIS patients presenting to the emergency department 21 VA hospitals before and after telestroke implementation. Transfer rates were determined through review of administrative data and chart review and patient and facility level characteristics were collected to identify predictors of transfer. Comparisons were made using t-test, Wilcoxon rank sum, and chi-square analysis. Multivariable logistic regression with sensitivity analyses were conducted to assess the influence of telestroke implementation on transfer rates. RESULTS We analyzed 3,488 stroke encounters (1,056 pre-NTSP and 2,432 post-NTSP). Following implementation, we observed an absolute 14.4% decrease in transfers across all levels of stroke center designation. Younger age, higher stroke severity, and shorter duration from symptom onset were associated with transfer. At the facility level, hospitals with lower annual stroke volume were more likely to transfer although only one hospital actually saw an increase in transfer rates following implementation. After adjusting for patient and facility characteristics, the implementation of VA NTSP resulted in a nearly 60% reduction in odds of transfer (OR = 0.39, [0.19, 0.77]). CONCLUSIONS In addition to improving treatment in acute stroke, telestroke networks have the potential to positively impact the efficiency of interhospital networks through disposition optimization and the avoidance of unnecessary transfers.
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Affiliation(s)
- Michael J Lyerly
- Department of Neurology, University of Alabama at Birmingham.,Birmingham VA Medical Center.,VHA National Telestroke Program
| | - Joanne Daggy
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine
| | - Michelle LaPradd
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine
| | - Holly Martin
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine.,Health Services Research and Development (HSR&D) Center for Health Information and Communication, Roudebush VA Medical Center
| | - Brandon Edwards
- Health Services Research and Development (HSR&D) Center for Health Information and Communication, Roudebush VA Medical Center
| | - Glenn Graham
- VHA National Telestroke Program.,Department of Neurology, University of California San Francisco School of Medicine
| | | | | | - Linda S Williams
- Health Services Research and Development (HSR&D) Center for Health Information and Communication, Roudebush VA Medical Center.,Department of Neurology, Indiana University School of Medicine.,Regenstrief Institute, Inc
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4
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Pallesen LP, Winzer S, Hartmann C, Kuhn M, Gerber JC, Theilen H, Hädrich K, Siepmann T, Barlinn K, Rahmig J, Linn J, Barlinn J, Puetz V. Team Prenotification Reduces Procedure Times for Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Who Are Transferred for Endovascular Therapy. Front Neurol 2022; 12:787161. [PMID: 35046884 PMCID: PMC8761669 DOI: 10.3389/fneur.2021.787161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The clinical benefit from endovascular therapy (EVT) for patients with acute ischemic stroke is time-dependent. We tested the hypothesis that team prenotification results in faster procedure times prior to initiation of EVT. Methods: We analyzed data from our prospective database (01/2016–02/2018) including all patients with acute ischemic stroke who were evaluated for EVT at our comprehensive stroke center. We established a standardized algorithm (EVT-Call) in 06/2017 to prenotify team members (interventional neuroradiologist, neurologist, anesthesiologist, CT and angiography technicians) about patient transfer from remote hospitals for evaluation of EVT, and team members were present in the emergency department at the expected patient arrival time. We calculated door-to-image, image-to-groin and door-to-groin times for patients who were transferred to our center for evaluation of EVT, and analyzed changes before (–EVT-Call) and after (+EVT-Call) implementation of the EVT-Call. Results: Among 494 patients in our database, 328 patients were transferred from remote hospitals for evaluation of EVT (208 -EVT-Call and 120 +EVT-Call, median [IQR] age 75 years [65–81], NIHSS score 17 [12–22], 49.1% female). Of these, 177 patients (54%) underwent EVT after repeated imaging at our center (111/208 [53%) -EVT-Call, 66/120 [55%] +EVT-Call). Median (IQR) door-to-image time (18 min [14–22] vs. 10 min [7–13]; p < 0.001), image-to-groin time (54 min [43.5–69.25] vs. 47 min [38.3–58.75]; p = 0.042) and door-to-groin time (74 min [58–86.5] vs. 60 min [49.3–71]; p < 0.001) were reduced after implementation of the EVT-Call. Conclusions: Team prenotification results in faster patient assessment and initiation of EVT in patients with acute ischemic stroke. Its impact on functional outcome needs to be determined.
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Affiliation(s)
- Lars-Peder Pallesen
- Department of Neurology, Dresden NeuroVascular Center, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Simon Winzer
- Department of Neurology, Dresden NeuroVascular Center, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Christian Hartmann
- Department of Neurology, Dresden NeuroVascular Center, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Matthias Kuhn
- Carl Gustav Carus Faculty of Medicine, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Johannes C Gerber
- Institute of Neuroradiology, Dresden Neurovascular Center, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Hermann Theilen
- Department of Anesthesiology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Kevin Hädrich
- Institute of Neuroradiology, Dresden Neurovascular Center, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, Dresden NeuroVascular Center, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, Dresden NeuroVascular Center, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Jan Rahmig
- Department of Neurology, Dresden NeuroVascular Center, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Jennifer Linn
- Institute of Neuroradiology, Dresden Neurovascular Center, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Jessica Barlinn
- Department of Neurology, Dresden NeuroVascular Center, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, Dresden NeuroVascular Center, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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5
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Simon E, Forghani M, Abramyuk A, Winzer S, Wojciechowski C, Pallesen LP, Siepmann T, Reichmann H, Puetz V, Barlinn K, Barlinn J. Intravenous Thrombolysis by Telestroke in the 3- to 4.5-h Time Window. Front Neurol 2021; 12:756062. [PMID: 34899575 PMCID: PMC8661095 DOI: 10.3389/fneur.2021.756062] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: While intravenous thrombolysis (IVT) in ischemic stroke can be safely applied in telestroke networks within 3 h from symptom onset, there is a lack of evidence for safety in the expanded 3- to 4. 5-h time window. We assessed the safety and short-term efficacy of IVT in acute ischemic stroke (AIS) in the expanded time window delivered through a hub-and-spoke telestroke network. Methods: Observational study of patients with AIS who received IVT at the Stroke Eastern Saxony Telemedical Network between 01/2014 and 12/2015. We compared safety data including symptomatic intracerebral hemorrhage (sICH; according to European Cooperative Acute Stroke Study II definition) and any intracerebral hemorrhage (ICH) between patients admitted to telestroke spoke sites and patients directly admitted to a tertiary stroke center representing the hub of the network. We also assessed short-term efficacy data including favorable functional outcome (i.e., modified Rankin Scale ≤ 2) and National Institutes of Health Stroke Scale (NIHSS) at discharge, hospital discharge disposition, and in-hospital mortality. Results: In total, 152 patients with AIS were treated with IVT in the expanded time window [spoke sites, n = 104 (26.9%); hub site, n = 48 (25.9%)]. Patients treated at spoke sites had less frequently a large vessel occlusion [8/104 (7.7) vs. 20/48 (41.7%); p < 0.0001], a determined stroke etiology (p < 0.0001) and had slightly shorter onset-to-treatment times [210 (45) vs. 228 (58) min; p = 0.02] than patients who presented to the hub site. Both cohorts did not display any further differences in demographics, vascular risk factors, median baseline NIHSS scores, or median baseline Alberta stroke program early CT score (p > 0.05). There was no difference in the frequency of sICH (4.9 vs. 6.3%; p = 0.71) or any ICH (8.7 vs. 16.7%; p = 0.15). Neither there was a difference regarding favorable functional outcome (44.1 vs. 39.6%; p = 0.6) nor median NIHSS [3 (5.5) vs. 2.5 (5.75); p = 0.92] at discharge, hospital discharge disposition (p = 0.28), or in-hospital mortality (9.6 vs. 8.3%; p = 1.0). Multivariable modeling did not reveal an association between telestroke and sICH or favorable functional outcome (p > 0.05). Conclusions: Delivery of IVT in the expanded 3- to 4.5-h time window through a telestroke network appears to be safe with equivalent short-term functional outcomes for spoke-and-hub center admissions.
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Affiliation(s)
- Erik Simon
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Matin Forghani
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andrij Abramyuk
- Department of Radiology, Institute of Neuroradiology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - Simon Winzer
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Claudia Wojciechowski
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jessica Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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6
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Busti C, Gamboni A, Calabrò G, Zampolini M, Zedde M, Caso V, Corea F. Telestroke: Barriers to the Transition. Front Neurol 2021; 12:689191. [PMID: 34594291 PMCID: PMC8476832 DOI: 10.3389/fneur.2021.689191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/27/2021] [Indexed: 01/17/2023] Open
Affiliation(s)
- Chiara Busti
- Emergency Department, San Giovanni Battista Hospital of Foligno, Umbria, Italy
| | - Alessio Gamboni
- Emergency Department, San Giovanni Battista Hospital of Foligno, Umbria, Italy
| | - Giuseppe Calabrò
- Emergency Department, San Giovanni Battista Hospital of Foligno, Umbria, Italy
| | - Mauro Zampolini
- Stroke Unit, San Giovanni Battista Hospital of Foligno, Umbria, Italy
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valeria Caso
- Stroke Unit, Santa Maria Misericordia Hospital, Perugia, Italy
| | - Francesco Corea
- Stroke Unit, San Giovanni Battista Hospital of Foligno, Umbria, Italy
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7
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Abstract
Objectives: Concise “synthetic” review of the state of the art of management of acute ischemic stroke. Data Sources: Available literature on PubMed. Study Selection: We selected landmark studies, recent clinical trials, observational studies, and professional guidelines on the management of stroke including the last 10 years. Data Extraction: Eligible studies were identified and results leading to guideline recommendations were summarized. Data Synthesis: Stroke mortality has been declining over the past 6 decades, and as a result, stroke has fallen from the second to the fifth leading cause of death in the United States. This trend may follow recent advances in the management of stroke, which highlight the importance of early recognition and early revascularization. Recent studies have shown that early recognition, emergency interventional treatment of acute ischemic stroke, and treatment in dedicated stroke centers can significantly reduce stroke-related morbidity and mortality. However, stroke remains the second leading cause of death worldwide and the number one cause for acquired long-term disability, resulting in a global annual economic burden. Conclusions: Appropriate treatment of ischemic stroke is essential in the reduction of mortality and morbidity. Management of stroke involves a multidisciplinary approach that starts and extends beyond hospital admission.
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8
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Hubert GJ, Corea F, Schlachetzki F. The role of telemedicine in acute stroke treatment in times of pandemic. Curr Opin Neurol 2021; 34:22-26. [PMID: 33230037 DOI: 10.1097/wco.0000000000000887] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 (COVID-19) pandemic challenges many healthcare systems. This review provides an overview of the advantages of telemedicine during times of pandemic and the changes that have followed the outbreak of the COVID-19 disease. RECENT FINDINGS Telemedicine has been utilized during infectious outbreaks for many years. COVID-19 has induced a variety of changes in laws (i.e. data privacy protection) and reimbursement procedures to accelerate new setups of telemedicine. Existing networks provide novel data about teleactivation resulting from social restrictions during the nadir of the lockdown in spring 2020. SUMMARY Telemedicine is a safe and ideal expert support system for hospitals during infectious outbreaks. It makes high-quality medical procedures possible, limits potentially contagious interhospital transfers, saves critical resources such as protective gear and rescue/emergency transport services, and offers safe home office work for medical specialists.
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Affiliation(s)
- Gordian J Hubert
- TEMPiS Telemedical Stroke Center, Department of Neurology, München Klinik Harlaching, Munich, Germany
| | - Francesco Corea
- Stroke and Neurology Clinic, San Giovanni Battista Hospital, Foligno, Italy
| | - Felix Schlachetzki
- TEMPiS Telemedical Stroke Center, Department of Neurology, Center for Vascular Neurology and Intensive Care, University of Regensburg, Medbo Bezirksklinikum
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9
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Langhorne P, Audebert HJ, Cadilhac DA, Kim J, Lindsay P. Stroke systems of care in high-income countries: what is optimal? Lancet 2020; 396:1433-1442. [PMID: 33129394 DOI: 10.1016/s0140-6736(20)31363-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 01/19/2023]
Abstract
Stroke is a complex, time-sensitive, medical emergency that requires well functioning systems of care to optimise treatment and improve patient outcomes. Education and training campaigns are needed to improve both the recognition of stroke among the general public and the response of emergency medical services. Specialised stroke ambulances (mobile stroke units) have been piloted in many cities to speed up the diagnosis, triage, and emergency treatment of people with acute stroke symptoms. Hospital-based interdisciplinary stroke units remain the central feature of a modern stroke service. Many have now developed a role in the very early phase (hyperacute units) plus outreach for patients who return home (early supported discharge services). Different levels (comprehensive and primary) of stroke centre and telemedicine networks have been developed to coordinate the various service components with specialist investigations and interventions including rehabilitation. Major challenges include the harmonisation of resources for stroke across the whole patient journey (including the rapid, accurate triage of patients who require highly specialised treatment in comprehensive stroke centres) and the development of technology to improve communication across different parts of a service.
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Affiliation(s)
- Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Royal Infirmary, Glasgow, UK.
| | - Heinrich J Audebert
- Department of Neurology and Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dominique A Cadilhac
- Monash University, Department of Medicine, School of Clinical Sciences at Monash Health, Clayton, VIC, Australia
| | - Joosup Kim
- Monash University, Department of Medicine, School of Clinical Sciences at Monash Health, Clayton, VIC, Australia
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10
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Sanchez S, Campos Y, Cadena A, Habib S, Deprince M, Chalouhi N, Vibbert M, Urtecho J, Athar MK, Tzeng D, Sheehan L, Bell R, Tjoumakaris S, Jabbour P, Rosenwasser R, Rincon F. Intravenous thrombolysis in the elderly is facilitated by a tele-stroke network: A cross-sectional study. Clin Neurol Neurosurg 2020; 197:106177. [PMID: 32861925 DOI: 10.1016/j.clineuro.2020.106177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Data suggest that elderly patients have less favorable outcomes after ischemic stroke. OBJECTIVE To study the outcomes after intravenous tissue plasminogen activator (tPA) administration in elderly patients with acute ischemic stroke. METHODS Cross-sectional study using prospective collected patient data maintained via our "tele-stroke" network, which provides acute care in 29 community hospitals within our region from 2013-2015. Exposure of interest was age divided into >80 years (octogenarian) or younger. Outcomes of interest were rate of intravenous tPA administration, hemorrhagic transformation (ICH), in-hospital neurological deterioration, and poor outcome defined as a composite of hospital discharge to long-term care facility or death. RESULTS Mean age 67 ± 16 years, 57 % (743/1317) were women, and median (Md) NIHSS was 4 (Interquartile Range [IQR] 8). The rate of tPA was 20 % (267/1317). Compared to reported rates of tPA administration in the nation, our tPA rate exceeded the one from the literature (20 % v 3%, z = 2.83, SE = 0.04, p = .005). There were no differences in ICH or neurological deterioration. The octogenarian group had a higher proportion of poor-outcome (61 % vs. 23 %, p < 0.001) than the younger group but similar in-hospital case-fatality (25 % v 14 %, p = 0.09). Predictors of poor-outcome were age >80 (OR 4.9; CI, 2.0-12, p < .001) and α-NIHSS>9. (OR 8.7; CI, 3.5-20, p < .001). CONCLUSION Our data suggest that in our "tele-stroke" network, rates of tPA administration are higher than those reported in the literature and that this rate was not different in octogenarians compared to younger patients. Octogenarians were not at risk for ICH or neurological deterioration after tPA administration. However, octogenarians had a higher risk of poor outcome.
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Affiliation(s)
- Sebastian Sanchez
- Department of Neurosurgery, Thomas Jefferson University, United States
| | - Yesica Campos
- Department of Neurology, University of Alabama, United States
| | - Angel Cadena
- Department of Neurosurgery, Thomas Jefferson University, United States
| | - Sara Habib
- Department of Neurosurgery, Thomas Jefferson University, United States
| | | | - Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University, United States
| | - Matthew Vibbert
- Department of Neurosurgery, Thomas Jefferson University, United States
| | | | - M Kamran Athar
- Department of Neurosurgery, Thomas Jefferson University, United States
| | - Diana Tzeng
- Department of Neurology, Thomas Jefferson University, United States
| | - Lori Sheehan
- Department of Neurology, Thomas Jefferson University, United States
| | - Rodney Bell
- Department of Neurology, Thomas Jefferson University, United States
| | | | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, United States
| | | | - Fred Rincon
- Department of Neurosurgery, Thomas Jefferson University, United States; Department of Neurology, Thomas Jefferson University, United States.
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11
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Safety of inter-hospital transfer of patients with acute ischemic stroke for evaluation of endovascular thrombectomy. Sci Rep 2020; 10:5655. [PMID: 32221353 PMCID: PMC7101346 DOI: 10.1038/s41598-020-62528-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/15/2020] [Indexed: 11/09/2022] Open
Abstract
Stroke networks facilitate access to endovascular treatment (EVT) for patients with ischemic stroke due to large vessel occlusion. In this study we aimed to determine the safety of inter-hospital transfer and included all patients with acute ischemic stroke who were transferred within our stroke network for evaluation of EVT between 06/2016 and 12/2018. Data were derived from our prospective EVT database and transfer protocols. We analyzed major complications and medical interventions associated with inter-hospital transfer. Among 615 transferred patients, 377 patients (61.3%) were transferred within our telestroke network and had transfer protocols available (median age 76 years [interquartile range, IQR 17], 190 [50.4%] male, median baseline NIHSS score 17 [IQR 8], 246 [65.3%] drip-and-ship i.v.-thrombolysis). No patient suffered from cardio-respiratory failure or required emergency intubation or cardiopulmonary resuscitation during the transfer. Among 343 patients who were not intubated prior departure, 35 patients (10.2%) required medical interventions during the transfer. The performance of medical interventions was associated with a lower EVT rate and higher mortality at three months. In conclusion, the transfer of acute stroke patients for evaluation of EVT was not associated with major complications and transfer-related medical interventions were required in a minority of patients.
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12
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Moustafa H, Barlinn K, Prakapenia A, Winzer S, Gerber J, Pallesen LP, Siepmann T, Haedrich K, Wojciechowski C, Reichmann H, Linn J, Puetz V, Barlinn J. Endovascular therapy for anterior circulation large vessel occlusion in telestroke. J Telemed Telecare 2019; 27:159-165. [PMID: 31390946 DOI: 10.1177/1357633x19867193] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Recent exploratory analysis suggested comparable outcomes among stroke patients undergoing endovascular therapy (EVT) for anterior circulation large vessel occlusion, whether selected via the telestroke network or admitted directly to an EVT-capable centre. We further studied the role of telemedicine in selection of ischaemic stroke patients potentially eligible for EVT. METHODS We prospectively included consecutive ischaemic stroke patients with anterior circulation large vessel occlusion who underwent EVT at our neurovascular centre (January 2016 to March 2018). We compared safety and efficacy including symptomatic intracerebral haemorrhage (sICH), successful reperfusion (mTICI 2b/3), 90-day favourable outcome (mRS ≤ 2) and 90-day survival between patients transferred from telestroke hospitals and patients directly admitted. RESULTS Of 280 potentially EVT-eligible patients, 72/129 (56%) telestroke and 91/151 (60%) direct admissions eventually underwent EVT (age 76 (66-82) years, median (interquartile range), 46% men, NIHSS score 17 (13-20)). Telestroke patients had larger pre-EVT infarct cores (ASPECTS: 7 (6-8) vs. 8 (7-9); p < 0.0001) and shorter door-to-groin puncture times (71 (56-84) vs. 101 (79-133) min; p < 0.0001) than directly admitted patients. sICH (2.8% vs. 1.1%; p = 0.58), successful reperfusion (81% vs. 77%; p = 0.56), 90-day favourable outcome (25% vs. 29%; p = 0.65) and 90-day survival (73% vs. 67%; p = 0.39) rates were comparable among telestroke and direct admissions. DISCUSSION Our data underpins the important role of telemedicine in identifying acute ischaemic stroke patients lacking immediate access to EVT-capable stroke centres. Stroke patients selected via telemedicine and those directly admitted had comparable chances of favourable outcomes after EVT for large vessel occlusion.
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Affiliation(s)
- Haidar Moustafa
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Alexandra Prakapenia
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Simon Winzer
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Johannes Gerber
- Department of Neuroradiology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Kevin Haedrich
- Department of Neuroradiology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Claudia Wojciechowski
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Jennifer Linn
- Department of Neuroradiology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Volker Puetz
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Jessica Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
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Ye S, Hu S, Lei Z, Li Z, Li W, Sui Y, Ren L. Shenzhen stroke emergency map improves access to rt-PA for patients with acute ischaemic stroke. Stroke Vasc Neurol 2019; 4:115-122. [PMID: 31709116 PMCID: PMC6812643 DOI: 10.1136/svn-2018-000212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 01/01/2023] Open
Abstract
Prehospital delay is one of the major causes of low rate of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis for acute ischaemic stroke in China. Regional emergency systems have been proven a successful approach to improve access to thrombolysis. Shenzhen is a high population density city with great geographical disparity of healthcare resources, leading to limited access to rt-PA thrombolysis for most patients with acute ischaemic stroke. To improve rapid access to rt-PA thrombolysis in Shenzhen, a Shenzhen stroke emergency map was implemented by Shenzhen healthcare administrations. This map comprised certification of qualified local hospitals, identification of patients with stroke, acute stroke transport protocol and maintenance of the map. We conducted a retrospective observational study to compare consecutive patients with acute stroke arriving at qualified local hospitals before and after implementation of the Shenzhen stroke emergency map. After implementation of the map, the rate of patients receiving rt-PA thrombolysis increased from 8.3% to 9.7% (p=0.003), and the rate of patients treated with endovascular thrombectomy increased from 0.9% to 1.6% (p<0.001). Sixteen of 20 hospitals have an increase in the number of patients with stroke treated with rt-PA thrombolysis. The median time between receipt of the call and arrival on the scene reduced significantly (17.0 min vs 9.0 min, p<0.001). In Shenzhen Second People's Hospital, the median onset-to-needle time and door-to-needle time were reduced (175.5 min vs 149.5 min, p=0.039; 71.5 min vs 51.5 min, p<0.001). No statistically significant differences were found in the proportion of rt-PA-treated patients within various geographical distances. Currently, there are more than 40 cities in China implementing a stroke emergency map. The Shenzhen stroke emergency map improves access to rt-PA thrombolysis for acute ischaemic stroke, and the novel model has been expanded to multiple areas in China. Future efforts should be conducted to optimise the stroke emergency map.
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Affiliation(s)
- Shisheng Ye
- Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen Second People's Hospital, Shenzhen, China
| | - Shiyu Hu
- Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhihao Lei
- Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhichao Li
- Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen Second People's Hospital, Shenzhen, China
| | - Weiping Li
- Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yi Sui
- Department of Neurology, Shenyang First People's Hospital, Shenyang Medical College, Shenyang, China
| | - Lijie Ren
- Department of Neurology, Shenzhen University First Affiliated Hospital, Shenzhen Second People's Hospital, Shenzhen, China
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Expansion of Telemedicine Services: Telepharmacy, Telestroke, Teledialysis, Tele-Emergency Medicine. Crit Care Clin 2019; 35:519-533. [PMID: 31076051 DOI: 10.1016/j.ccc.2019.02.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As more specialized care gets centralized in centers of excellence, patients admitted to rural hospitals may be at a disadvantage at the time of accessing expertise or receiving advanced care. In this setting, telemedicine models provide a justification to equalize care across different levels. The diversity in telemedicine services is vast and is expanding. Even with all the subsets of telemedicine, including telepharmacy, telestroke, teledialysis, and tele-emergency medicine, the reasons for providing services and associated limitations are similar. However, there is a lack of empirical research including best practices and resultant outcomes for these subsets of telemedicine models.
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Hoffman AM, Lapcharoensap W, Huynh T, Lund K. Historical Perspectives: Telemedicine in Neonatology. Neoreviews 2019; 20:e113-e123. [PMID: 31261049 DOI: 10.1542/neo.20-3-e113] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Telemedicine is fast becoming integrated into health care as a way to increase access for patients, particularly across the urban/rural divide. Use of telemedicine in neonatology is a newer, yet rapidly expanding modality. This review outlines the history of telemedicine, the evolution of its current uses in neonatology, requirements for starting a telemedicine program, and potential future uses.
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Affiliation(s)
- Amber M Hoffman
- Department of Telehealth Services, Oregon Health & Science University, Portland, OR
| | - Wannasiri Lapcharoensap
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Trang Huynh
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Kelli Lund
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
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Whetten J, van der Goes DN, Tran H, Moffett M, Semper C, Yonas H. Cost-effectiveness of Access to Critical Cerebral Emergency Support Services (ACCESS): a neuro-emergent telemedicine consultation program. J Med Econ 2018; 21:398-405. [PMID: 29316820 DOI: 10.1080/13696998.2018.1426591] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS Access to Critical Cerebral Emergency Support Services (ACCESS) was developed as a low-cost solution to providing neuro-emergent consultations to rural hospitals in New Mexico that do not offer comprehensive stroke care. ACCESS is a two-way audio-visual program linking remote emergency department physicians and their patients to stroke specialists. ACCESS also has an education component in which hospitals receive training from stroke specialists on the triage and treatment of patients. This study assessed the clinical and economic outcomes of the ACCESS program in providing services to rural New Mexico from a healthcare payer perspective. METHODS A decision tree model was constructed using findings from the ACCESS program and existing literature, the likelihood that a patient will receive a tissue plasminogen activator (tPA), cost of care, and resulting quality adjusted life years (QALYs). Data from the ACCESS program includes emergency room patients in rural New Mexico from May 2015 to August 2016. Outcomes and costs have been estimated for patients who were taken to a hospital providing neurological telecare and patients who were not. RESULTS The use of ACCESS decreased neuro-emergent stroke patient transfers from rural hospitals to urban settings from 85% to 5% (no tPA) and 90% to 23% (tPA), while stroke specialist reading of patient CT/MRI imaging within 3 h of onset of stroke symptoms increased from 2% to 22%. Results indicate that use of ACCESS has the potential to save $4,241 ($3,952-$4,438) per patient and increase QALYs by 0.20 (0.14-0.22). This increase in QALYs equates to ∼73 more days of life at full health. The cost savings and QALYs are expected to increase when moving from a 90-day model to a lifetime model. CONCLUSION The analysis demonstrates potential savings and improved quality-of-life associated with the use of ACCESS for patients presenting to rural hospitals with acute ischemic stroke (AIS).
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Affiliation(s)
- Justin Whetten
- a Department of Economics , University of New Mexico , Albuquerque , NM , USA
| | | | - Huy Tran
- b Department of Neurosurgery , University of New Mexico , Albuquerque , NM , USA
| | - Maurice Moffett
- a Department of Economics , University of New Mexico , Albuquerque , NM , USA
| | - Colin Semper
- b Department of Neurosurgery , University of New Mexico , Albuquerque , NM , USA
| | - Howard Yonas
- b Department of Neurosurgery , University of New Mexico , Albuquerque , NM , USA
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Transfer of Patients in a Telestroke Network: What Are the Relevant Factors for Making This Decision? Telemed J E Health 2018; 24:116-120. [DOI: 10.1089/tmj.2017.0087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ince B, Necioglu D. Organization of stroke care in Turkey. Int J Stroke 2016; 12:105-107. [PMID: 28004992 DOI: 10.1177/1747493016672084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stroke is one of the major health problems in Turkey. Since cerebrovascular disease is the second leading cause of death, institutional organizations are important to decrease the burden of stroke in our country. Although the number of comprehensive stroke centers has been increasing constantly and many significant improvements have been realized in last years, there are still some regions without a comprehensive stroke center in Turkey.
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Affiliation(s)
- Birsen Ince
- 1 Division of Cerebrovascular Disease, Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Dilek Necioglu
- 2 Sisli Etfal Hastanesi, Neurology Clinic, Sisli, Istanbul, Turkey
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Barlinn J, Gerber J, Barlinn K, Pallesen LP, Siepmann T, Zerna C, Wojciechowski C, Puetz V, von Kummer R, Reichmann H, Linn J, Bodechtel U. Acute endovascular treatment delivery to ischemic stroke patients transferred within a telestroke network: a retrospective observational study. Int J Stroke 2016; 12:502-509. [PMID: 27899742 DOI: 10.1177/1747493016681018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Five randomized controlled trials recently demonstrated efficacy of endovascular treatment in acute ischemic stroke. Telestroke networks can improve stroke care in rural areas but their role in patients undergoing endovascular treatment is unknown. Aim We compared clinical outcomes of endovascular treatment between anterior circulation stroke patients transferred after teleconsultation and those directly admitted to a tertiary stroke center. Methods Data derived from consecutive patients with intracranial large vessel occlusion who underwent endovascular treatment from January 2010 to December 2014 at our tertiary stroke center. We compared baseline characteristics, onset-to-treatment times, symptomatic intracranial hemorrhage, in-hospital mortality, reperfusion (modified Treatment in Cerebral Infarction 2b/3), and favorable functional outcome (modified Rankin scale ≤ 2) at discharge between patients transferred from spoke hospitals and those directly admitted. Results We studied 151 patients who underwent emergent endovascular treatment for anterior circulation stroke: median age 70 years (interquartile range, 62-75); 55% men; median National Institutes of Health Stroke Scale score 15 (12-20). Of these, 48 (31.8%) patients were transferred after teleconsultation and 103 (68.2%) were primarily admitted to our emergency department. Transferred patients were younger (p = 0.020), received more frequently intravenous tissue plasminogen activator (p = 0.008), had prolonged time from stroke onset to endovascular treatment initiation (p < 0.0001) and tended to have lower rates of symptomatic intracranial hemorrhage (4.2% vs. 11.7%; p = 0.227) and mortality (8.3% vs. 22.6%; p = 0.041) than directly admitted patients. Similar rates of reperfusion (56.2% vs. 61.2%; p = 0.567) and favorable functional outcome (18.8% vs. 13.7%; p = 0.470) were observed in telestroke patients and those who were directly admitted. Conclusions Telestroke networks may enable delivery of endovascular treatment to selected ischemic stroke patients transferred from remote hospitals that is equitable to patients admitted directly to tertiary hospitals.
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Affiliation(s)
- Jessica Barlinn
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Johannes Gerber
- 2 Department of Neuroradiology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Kristian Barlinn
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Lars-Peder Pallesen
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Timo Siepmann
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Charlotte Zerna
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | | | - Volker Puetz
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Rüdiger von Kummer
- 2 Department of Neuroradiology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Heinz Reichmann
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Jennifer Linn
- 2 Department of Neuroradiology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Ulf Bodechtel
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
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Wechsler LR, Demaerschalk BM, Schwamm LH, Adeoye OM, Audebert HJ, Fanale CV, Hess DC, Majersik JJ, Nystrom KV, Reeves MJ, Rosamond WD, Switzer JA. Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 48:e3-e25. [PMID: 27811332 DOI: 10.1161/str.0000000000000114] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Telestroke is one of the most frequently used and rapidly expanding applications of telemedicine, delivering much-needed stroke expertise to hospitals and patients. This document reviews the current status of telestroke and suggests measures for ongoing quality and outcome monitoring to improve performance and to enhance delivery of care. METHODS A literature search was undertaken to examine the current status of telestroke and relevant quality indicators. The members of the writing committee contributed to the review of specific quality and outcome measures with specific suggestions for metrics in telestroke networks. The drafts were circulated and revised by all committee members, and suggestions were discussed for consensus. RESULTS Models of telestroke and the role of telestroke in stroke systems of care are reviewed. A brief description of the science of quality monitoring and prior experience in quality measures for stroke is provided. Process measures, outcomes, tissue-type plasminogen activator use, patient and provider satisfaction, and telestroke technology are reviewed, and suggestions are provided for quality metrics. Additional topics include licensing, credentialing, training, and documentation.
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Zerna C, von Kummer R, Gerber J, Engellandt K, Abramyuk A, Wojciechowski C, Barlinn K, Kepplinger J, Pallesen LP, Siepmann T, Dzialowski I, Reichmann H, Puetz V, Bodechtel U. Telemedical Brain Computed Tomography Misinterpretation by Stroke Neurologists Is Not Associated with Thrombolysis-Related Intracranial Hemorrhage. J Stroke Cerebrovasc Dis 2015; 24:1520-6. [PMID: 25873473 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/21/2015] [Accepted: 03/14/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Stroke Eastern Saxony Network (SOS-NET) provides telecare for acute stroke patients. Stroke neurologists recommend intravenous thrombolysis based on clinical assessment and cerebral computed tomography (CT) evaluation using Alberta Stroke Program Early CT score (ASPECTS). We sought to assess whether ASPECTS misinterpretation by stroke neurologists was associated with thrombolysis-related symptomatic intracranial hemorrhage (sICH). METHODS We retrospectively analyzed consecutive SOS-NET patients treated with thrombolytics from July 2007 to July 2012. Experienced neuroradiologists re-evaluated CT scans blinded to clinical information providing reference standard. We defined ASPECTS underestimation as ASPECTS stroke neurologist--ASPECTS neuroradiologist more than 1 point. Primary outcome was sICH by European Cooperative Acute Stroke Study II criteria. Secondary outcome was unfavorable outcome at discharge defined as modified Rankin Scale scores 3 or more. RESULTS Of 1659 patients with acute ischemic stroke, thrombolysis was performed in 657 patients. Complete primary outcome and imaging data were available for 432 patients (median age, 75; interquartile range [IQR], 12 years; National Institutes of Health Stroke Scale score, 12 [IQR, 11]; 52.8% women). Nineteen patients (4.4%) had sICH, and 259 patients (60.0%) had an unfavorable outcome at discharge. Interobserver agreement between ASPECTS assessment was fair (κ = .51). ASPECTS underestimation was neither associated with sICH (adjusted odds ratio (OR), 1.32; 95% confidence interval (CI), .36-4.83, P = .68) nor unfavorable outcome (adjusted OR, 1.10; 95% CI, .47-2.54; P = .83). CONCLUSIONS Despite fair interrater agreement between stroke neurologists and expert neuroradiologists, underestimation of ASPECTS by the former was not associated with thrombolysis-related sICH in our telestroke network.
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Affiliation(s)
- Charlotte Zerna
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - Ruediger von Kummer
- Division of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes Gerber
- Division of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Kai Engellandt
- Division of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Andrij Abramyuk
- Division of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Kristian Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jessica Kepplinger
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ulf Bodechtel
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
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Bodechtel U, Puetz V. Why Telestroke networks? Rationale, implementation and results of the Stroke Eastern Saxony Network. J Neural Transm (Vienna) 2013; 120 Suppl 1:S43-7. [DOI: 10.1007/s00702-013-1069-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 07/06/2013] [Indexed: 11/28/2022]
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