Erschienen in:
01.09.2014 | Original Communication
The effect of telestroke systems among neighboring hospitals: more and better? The Madrid Telestroke Project
verfasst von:
Patricia Martínez-Sánchez, Ambrosio Miralles, Rosa Sanz de Barros, Daniel Prefasi, Borja E. Sanz-Cuesta, Blanca Fuentes, Gerardo Ruiz-Ares, Marta Martínez-Martínez, Elena Miñano, Juan José Arévalo-Manso, Elisa Correas-Callero, Andrés Cruz-Herranz, Exuperio Díez-Tejedor
Erschienen in:
Journal of Neurology
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Ausgabe 9/2014
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Abstract
A telestroke system was established between a community hospital lacking an on-call neurologist and a comprehensive stroke center only 13 km away. Our goal was to analyze the impact of telestroke on the number of intravenous thrombolysis (IVT), door-to-needle times and stroke outcomes. An observational before-and-after study of patients with acute ischemic stroke (IS) who were attended in a community hospital during the 2 years before the telestroke system was implemented (pre-telestroke group) and the first 2 years after telestroke was established (telestroke group). The number of IVT, the door-to-needle time (min), the outcomes [modified Rankin Scale (mRS)] and the safety (mortality and hemorrhagic transformations) were compared between groups. During the pre-telestroke years, 259 patients with IS were attended (28 phone activations), 12 of whom received IVT (4.7 %). During the telestroke years, 225 patients with IS were attended (42 telestroke activations), of whom 18 (8 %) received IVT. The door-to-needle times were lower in the telestroke group [median interquartile range: 66 (54) vs. 143.5 (48) min, P < 0.0001]. The safety was similar in both groups; however, the 3-month mRS scores were lower in the telestroke group (P = 0.049). The multiple linear regression analysis showed a negative association between telestroke and door-to-needle time [β-coefficient (SE) = −59.089 (14.461)], adjusted for confounders. In conclusion, telestroke systems are effective, even between nearby hospitals, shortening door-to-needle time and improving stroke outcomes.