Elena López-Cancio1, Marc Ribó2, Pere Cardona3, Joaquín Serena4, Francisco Purroy5, Ernest Palomeras6, Josep Maria Aragonès7, Dolores Cocho8, Moisés Garcés9, Elsa Puiggròs10, Iñigo Soteras11, Ana Cabanelas12, David Villagrasa13, Ester Catena14, Eduard Sanjurjo15, Nuria López Claverol16, Dolors Carrión17, Mercè López18, Sònia Abilleira19,20, Antoni Dávalos21, Natalia Pérez de la Ossa21. 1. Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain. 2. Hospital Universitai Vall d'Hebrón, Barcelona, Spain. 3. Hospital Universitari Bellvitge, Barcelona, Spain. 4. Hospital Unversitari Josep Trueta, , Spain, Girona, Spain. 5. Hospital Universitari Arnau de Vilanova, IRBLleida. UdL, Lleida, Spain. 6. Hospital de Mataró, Barcelona, Spain. 7. Consorci Hospitalari de Vic, Barcelona, Spain. 8. Hospital General de Granollers, Barcelona, Spain. 9. Hospital Verge de la Cinta, Tarragona, Spain. 10. Hospital Sant Camil, Sant Pere de Ribes, Barcelona, Spain. 11. Hospital de la Cerdanya, Girona, Spain. 12. Hospital Palamós, Girona, Spain. 13. Hospital d'Igualada, Barcelona, Spain. 14. Hospital Comarcal Alt Penedès, Barcelona, Spain. 15. Hospital Comarcal del Pallars, Lleida, Spain. 16. Fundació Sant Hospital la Seu d'Urgell, Lleida, Spain. 17. Hospital Mora d'Ebre, Tarragona, Spain. 18. Hospital Figueres, Girona, Spain. 19. Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain. 20. CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain. 21. Hospital Germans Trias i Pujol, Barcelona, Spain.
Abstract
OBJECTIVES: The study aimed to evaluate the impact of a telestroke network on acute stroke care in Catalonia, by measuring thrombolysis rates, access to endovascular treatment, and clinical outcome of telestroke patients in a population-based study. METHODS: Telestroke network was implemented on March 2013 and consists of 12 community hospitals and 1 expert stroke neurologist 24 h/7 day, covering a population of 1.3 million inhabitants. Rest of the population (6.2 million) of Catalonia is covered by 8 primary stroke centers (PSC) and 6 comprehensive stroke centers (CSC). After a 2-way videoconference and visualization of neuroimaging on a web platform, the stroke neurologist decides the therapeutic approach and/or to transfer the patient to another facility, entering these data in a mandatory registry. Simultaneously, all patients treated with reperfusion therapies in all centers of Catalonia are prospectively recorded in a mandatory and audited registry. RESULTS: From March 2013 to December 2015, 1,206 patients were assessed by telestroke videoconference, of whom 322 received intravenous thrombolysis (IVT; 33.8% of ischemic strokes). Baseline and 24 h NIHSS, rate of symptomatic hemorrhage, mortality, and good outcome at 3 months were similar compared to those who received IVT in PSC or CSC (2,897 patients in the same period). The door-to-needle time was longer in patients treated through telestroke, but was progressively reduced from 2013 to 2015. Percentage of patients receiving thrombectomy after IVT was similar in patients treated through telestroke circuit, compared to those treated in PSC or CSC (conventional circuit). Population rates of IVT*100,000 inhabitants in Catalonia increased from 2011 to 2015, especially in areas affected by the implementation of telestroke network, achieving rates as high as 16 per 100,000 inhabitants. Transfers to another facility were avoided after telestroke consultation in 46.8% of ischemic, 76.5% of transient ischemic attacks, and 23.5% of hemorrhages. CONCLUSIONS: Telestroke favors safe and effective thrombolysis, helps to increase the population rate of IVT, and avoids a large number of interhospital transfers.
OBJECTIVES: The study aimed to evaluate the impact of a telestroke network on acute stroke care in Catalonia, by measuring thrombolysis rates, access to endovascular treatment, and clinical outcome of telestroke patients in a population-based study. METHODS: Telestroke network was implemented on March 2013 and consists of 12 community hospitals and 1 expert stroke neurologist 24 h/7 day, covering a population of 1.3 million inhabitants. Rest of the population (6.2 million) of Catalonia is covered by 8 primary stroke centers (PSC) and 6 comprehensive stroke centers (CSC). After a 2-way videoconference and visualization of neuroimaging on a web platform, the stroke neurologist decides the therapeutic approach and/or to transfer the patient to another facility, entering these data in a mandatory registry. Simultaneously, all patients treated with reperfusion therapies in all centers of Catalonia are prospectively recorded in a mandatory and audited registry. RESULTS: From March 2013 to December 2015, 1,206 patients were assessed by telestroke videoconference, of whom 322 received intravenous thrombolysis (IVT; 33.8% of ischemic strokes). Baseline and 24 h NIHSS, rate of symptomatic hemorrhage, mortality, and good outcome at 3 months were similar compared to those who received IVT in PSC or CSC (2,897 patients in the same period). The door-to-needle time was longer in patients treated through telestroke, but was progressively reduced from 2013 to 2015. Percentage of patients receiving thrombectomy after IVT was similar in patients treated through telestroke circuit, compared to those treated in PSC or CSC (conventional circuit). Population rates of IVT*100,000 inhabitants in Catalonia increased from 2011 to 2015, especially in areas affected by the implementation of telestroke network, achieving rates as high as 16 per 100,000 inhabitants. Transfers to another facility were avoided after telestroke consultation in 46.8% of ischemic, 76.5% of transient ischemic attacks, and 23.5% of hemorrhages. CONCLUSIONS: Telestroke favors safe and effective thrombolysis, helps to increase the population rate of IVT, and avoids a large number of interhospital transfers.
Authors: Caty Carrera; Natalia Cullell; Nuria Torres-Águila; Elena Muiño; Alejandro Bustamante; Antonio Dávalos; Elena López-Cancio; Marc Ribó; Carlos A Molina; Eva Giralt-Steinhauer; Carolina Soriano-Tárraga; Marina Mola-Caminal; Jordi Jiménez-Conde; Jaume Roquer; Cristófol Vives-Bauza; Rosa Díaz Navarro; Victor Obach; Juan Francisco Arenillas; Tomás Segura; Gemma Serrano-Heras; Joan Martí-Fàbregas; Marimar Freijo; Juan Antonio Cabezas; Turgut Tatlisumak; Laura Heitsch; Laura Ibañez; Carlos Cruchaga; Jin-Moo Lee; Daniel Strbian; Joan Montaner; Israel Fernández-Cadenas Journal: Neurology Date: 2019-07-31 Impact factor: 9.910
Authors: Katharina Feil; Jan Rémi; Clemens Küpper; Moriz Herzberg; Franziska Dorn; Wolfgang G Kunz; Paul Reidler; Johannes Levin; Katrin Hüttemann; Steffen Tiedt; Wanja Heidger; Katharina Müller; Dennis C Thunstedt; Rainer Dabitz; Robert Müller; Thomas Pfefferkorn; Gerhard F Hamann; Thomas Liebig; Marianne Dieterich; Lars Kellert Journal: J Neurol Date: 2020-09-05 Impact factor: 4.849
Authors: Leon Stephen Edwards; Christopher Blair; Dennis Cordato; Alan McDougall; Nathan Manning; Andrew Cheung; Jason Wenderoth; Cecilia Cappelen-Smith Journal: BMJ Neurol Open Date: 2020-04-05