Telemedicine for Safe and Extended Use of Thrombolysis in Stroke

Abstract

on behalf of the TEMPiS GroupBackground and Purpose-Systemic thrombolysis represents the only proven therapy for acute ischemic stroke, but safe treatment is reported only in established stroke units. One major goal of the ongoing Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria is to extend the use of tissue plasminogen activator (tPA) treatment in nonurban areas through telemedic support. Methods-The stroke centers in Munich-Harlaching and in Regensburg established a telestroke network to provide consultations for 12 local hospitals in eastern Bavaria. The telemedic system consists of a digital network that includes a 2-way video conference system and CT/MRI image transfer with a high-speed data transmission up to 2 Mb/s. Each network hospital established specialized stroke wards in which qualified teams treat acute stroke patients. Physicians in these hospitals are able to contact the stroke centers 24 hours per day. Results-A total of 106 systemic thrombolyses were indicated via teleconsultations between February 1, 2003, and April 7, 2004. During the first 12 months, the rate of thrombolyses was 2.1% of all stroke patients. Mean age was 68 years, and median National Institutes of Health Stroke Scale score was 13. Mean delay between onset and hospital admission was 65 minutes, and door-to-needle time was on average 76 minutes, which included 15 minutes for the teleconsultation. Symptomatic hemorrhage occurred in 8.5% of patients, and in-hospital mortality was 10.4%. Conclusions-The present data suggest that systemic thrombolysis indicated via stroke experts in the setting of teleconsultation exhibits similar complication rates to those reported in the National Institute of Neurological Disorders and Stroke trial. Therefore, tPA treatment is also safe in this context and can be extended to nonurban areas. (Stroke. 2005;36:287-291.)

Rural Victorian Telestroke project

“…This is comparable with overseas trials, including the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) study, which delivered a thrombolysis rate of 2.1% of all stroke patients in its first year of operation, although that trial used a 3-h time window. 16 In addition to introducing thrombolysis, we also aimed to improve the efficiency of stroke management by enhancing the rapidity of assessment and decisionmaking. Door-to-CT time was the variable measured to reflect this efficiency.…”

“…21 This is despite the proven safety of Telestroke thrombolysis in multiple randomised controlled trials. 16,22 Our study addressed these concerns by measuring the rate of symptomatic intracerebral haemorrhage, a standard safety measure used in thrombolysis trials. Comfortingly, no thrombolysed patients developed symptomatic intracerebral haemorrhage.…”

Segabrottnám við brátt blóðþurrðarslag er mesta framför í læknisfræði í áraraðir

“…53 Síðari rannsóknir sýndu fram á að haegt vaeri að baeta verkferla t-PA-gjafar með því að koma á laggir fjarlaekningum. Þessi nálgun á við um ákvörðunartöku t-PA-meðferðar, 54 útilokun einkenna sem líkjast slagi, 55 að tryggja rétt tímamörk, 56 túlkun myndrannsókna 57 auk þess að baeta greiningu og verkferla blóðþurrðarslaga. Gjöf t-PA jókst marktaekt eftir að fjarlaekningum var komið á án aukningar á rangri ákvarðanatöku.…”

Telestroke in Northern Alberta: A Two Year Experience with Remote Hospitals

“…Telemedicine provides an opportunity to optimize acute stroke treatment regardless of the geographical location. A large telemedicine based study has shown comparable safety and efficacy results in acute stroke patients treated with intravenous tPA via telemedicine conference using video and audio linkage 7 . Their findings suggested that physicians with little experience in treating acute stroke with thrombolytic agent, when guided remotely via telemedicine by stroke experts, could achieve comparable results to tertiary centres 7 .…”

“…A large telemedicine based study has shown comparable safety and efficacy results in acute stroke patients treated with intravenous tPA via telemedicine conference using video and audio linkage 7 . Their findings suggested that physicians with little experience in treating acute stroke with thrombolytic agent, when guided remotely via telemedicine by stroke experts, could achieve comparable results to tertiary centres 7 . A recent randomized control study comparing videoconferencing with computed tomography (CT) image review to telephone consultations without CT image review showed similar outcome at 90 days 8 .…”