Implementation of a telestroke system for general physicians without a nearby stroke center to shorten the time to intravenous thrombolysis for acute cerebral infarction

Ochiai, Hidenobu; Ohta, Hiroyuki; Kanemaru, Katsuhiro; Okuyama, Hironobu; Kume, Shuichi; Matsuda, Shuntaro; Kuroki, Kazuo; Kawachi, Kensuke; Takeshima, Hideo

doi:10.1002/ams2.551

Cited by 2 publications

(5 citation statements)

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“…In regions with low accessibility, achieving equitable access is a future challenge. For example, access can be enhanced by promoting the tele-stroke system as a healthcare policy ( 50 , 51 ). However, our findings suggest that increasing accessibility alone may not be sufficient to reduce the risk of stroke mortality.…”

Section: Discussionmentioning

confidence: 99%

Access to mechanical thrombectomy and ischemic stroke mortality in Japan: a spatial ecological study

Ohashi,

Osanai,

Fujiwara

et al. 2023

Front. Neurol.

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BackgroundAdvances in stroke treatment have greatly improved outcomes; however, disparities in access to treatment might increase. Achieving equitable access to stroke treatment is a health policy challenge, as rapid treatment is essential for positive outcomes. This ecological cross-sectional study aimed to determine the relationship between the disparities in spatial accessibility to mechanical thrombectomy (SAMT) and stroke mortality rates in Japan, hypothesizing that disparities in SAMT may increase the differences in stroke mortality between regions.MethodsWe used the average number of ischemic stroke (IS) deaths between 2020 and 2021 as the response variable; and SAMT, medical resources, and socioeconomic characteristics of each municipality as explanatory variables. A conditional autoregressive model was used to examine the association between the risk of stroke mortality and SAMT. The standardized mortality ratio (SMR) was mapped to understand the nationwide disparities in stroke mortality risk.ResultsThe median number of IS deaths was 17.5 persons per year in the municipalities (2020 to 2021). The study also found that municipalities with low SAMT were located in the northern part of Japan. The non-spatial regression model results indicated that poor accessibility, a small proportion of bachelor’s degrees or higher, and a high proportion of workers in secondary industries were related to high IS mortality. Three models were evaluated using spatial analysis; Model 1 with accessibility indicators alone, Model 2 with medical resources added to Model 1, and Model 3 with socioeconomic characteristics added to Model 2. In Models 1 and 2, the population-weighted spatial accessibility index (PWSAI) showed a significant negative relationship with stroke mortality. However, this was not evident in Model 3. Mapping using Model 3 showed that the high-risk areas were predominantly located in northern Japan, excluding Hokkaido.ConclusionAccess to mechanical thrombectomy was estimated, and regional differences were observed. The relationship between accessibility and IS mortality is unknown; however, regardless of accessibility, municipalities with a high proportion of workers in secondary industries and a small proportion with bachelor’s degrees or above are at risk of death from stroke.

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Section: Discussionmentioning

confidence: 99%

Access to mechanical thrombectomy and ischemic stroke mortality in Japan: a spatial ecological study

Ohashi,

Osanai,

Fujiwara

et al. 2023

Front. Neurol.

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“…It is necessary to initiate rt-PA therapy as soon as possible to improve prognosis after AIS in an area where there are no nearby stroke centers, neurosurgeons, or neurologists, such as in our case. In these situations, general physicians are expected to administer rt-PA with telestroke support to shorten the time between the onset of symptoms and the initiation of rt-PA therapy 8 , 10 , 11 ) . Most telestroke systems in recent years were intended for neurosurgeons or neurologists to provide consultations in hospitals without a stroke specialist regarding the indications for endovascular mechanical thrombectomy 12 , 13 ) .…”

Section: Discussionmentioning

confidence: 99%

“…In other words, it is necessary to establish a telemedicine system that encourages all physicians who are in charge of the initial examination to administer rt-PA therapy regardless of their specialty. However, to mitigate errors, assistance is required during the assessment of neurological symptoms, calculation of the NIHSS scores, and double-checking the dose of rt-PA. For these reasons, we established a new type of stroke telemedicine support system that enabled the sharing of images and “face-to-face” discussions with stroke specialists about the patient’s symptoms, diagnosis, and treatment using a mobile device with a thin-client viewer system and videophone 8 ) .…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…To encourage general physicians to administer rt-PA therapy without delays and risks, we established a new type of stroke telemedicine support system, which we reported previously 8 ) . This program enabled the sharing of images and “face-to-face” discussions of symptoms, diagnosis, and treatment options with stroke specialists using a mobile device with a thin-client viewer system and videophone 8 ) . In our previous report, we showed the efficacy of this telestroke system in reducing the time to administer intravenous thrombolysis in cases of acute cerebral infarction; however, we could not show its efficacy on improving the prognosis of patients 8 ) .…”

Section: Introductionmentioning

confidence: 99%

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A case of acute cerebral infarction with a favorable prognosis after rt-PA administration by a general physician with telestroke support

Ochiai

Kanemaru

Matsuda³

et al. 2021

J Rural Med

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Objective: Herein, we report a patient with acute cerebral infarction with a favorable prognosis after being managed by a general physician with support from the telestroke program. Patient and Methods: An 85-year-old man was transferred to a regional hospital due to sudden onset of dysarthria and left hemiparesis. As no neurosurgeons or neurologists were available in that hospital or area, the patient was examined by a general physician who diagnosed him with cardioembolic stroke on the left middle cerebral artery territory. The physician consulted a stroke specialist using the telestroke system; with the support from the telestroke program, the physician administered thrombolytic therapy 4 hours and 10 minutes after the onset of symptoms. Results: The patient’s National Institutes of Health Stroke Scale score improved from 9 to 3 and he was subsequently transferred to the stroke center. However, the occluded left middle cerebral artery had already re-canalized. His hemiparesis completely improved one week after the onset. Conclusion: A telemedicine system for general physicians is indispensable in areas without accessible stroke specialists as it provides access to a standard of care for hyper-acute stroke patient assessment and management, and helps improve neuroprognosis.

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Implementation of a telestroke system for general physicians without a nearby stroke center to shorten the time to intravenous thrombolysis for acute cerebral infarction

Cited by 2 publications

References 14 publications

Access to mechanical thrombectomy and ischemic stroke mortality in Japan: a spatial ecological study

Access to mechanical thrombectomy and ischemic stroke mortality in Japan: a spatial ecological study

A case of acute cerebral infarction with a favorable prognosis after rt-PA administration by a general physician with telestroke support

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