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Use of telemedicine to manage severe ischaemic strokes in a rural area with an elderly population

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Abstract

The rural district of the Meuse (East France) has a high number of elderly patients for whom prognosis of ischaemic strokes is poor with high-haemorrhagic transformation risk of intravenous tissue plasminogen activator (rt-PA). This disadvantage is made worse by the distances a patient has to travel to the nearest stroke unit. We set out to assess the effectiveness of a telestroke system implemented in this area. Between October 2010 and February 2012, data from each “tele-expertised” patient were collected. 53 patients were examined. Diagnosis of ischaemic stroke was confirmed in 43 cases (81 %), and intravenous rt-PA treatment performed in 21 cases (40 %). In the treated patient group, median age was 73 years, with 29 % of octogenarians. Baseline National Institutes of Health Stroke Scale (NIHSS) was 16, with 29 % ≥ 20. The median onset to needle time was 169 min, and the median door to needle time was 69 min. Intracranial haemorrhage occurred in 3 cases (14 %), and was symptomatic in two (10 %). At 3 months, median NIHSS was 6, 6 patients (29 %) presented a favourable outcome (modified Rankin scale ≤1) and 3 (14 %) had died. In rural areas, for elderly patients with severe ischaemic strokes, telemedicine appears to be a way of improving accessibility and benefits of rt-PA treatment.

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References

  1. Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, Brott T, Frankel M, Grotta JC, Haley EC Jr, Kwiatkowski T, Levine SR, Lewandowski C, Lu M, Lyden P, Marler JR, Patel S, Tilley BC, Albers G, Bluhmki E, Wilhelm M, Hamilton S, ATLANTIS Trials Investigators; ECASS Trials Investigators; NINDS rt-PA Study Group Investigators (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363:768–774

    Article  PubMed  Google Scholar 

  2. Bhatnagar P, Sinha D, Parker RA, Guyler P, O’Brien A (2011) Intravenous thrombolysis in acute ischaemic stroke: a systematic review and meta-analysis to aid decision making in patients over 80 years of age. J Neurol Neurosurg Psychiatry 82:712–717. doi:10.1136/jnnp.2010.223149

    Article  PubMed  Google Scholar 

  3. Pedragosa A, Alvarez-Sabin J, Molina CA, Sanclemente C, Martín MC, Alonso F, Ribo M (2009) Impact of a telemedicine system on acute stroke care in a community hospital. J Telemed Telecare 15:260–263. doi:10.1258/jtt.2009.090102

    Article  PubMed  Google Scholar 

  4. de Bustos EM, Vuillier F, Chavot D, Moulin T (2009) Telemedicine in stroke: organizing a network—rationale and baseline principles. Cerebrovasc Dis 27:1–8. doi:10.1159/000213052

    Article  PubMed  Google Scholar 

  5. Henninger N, Chowdhury N, Fisher M, Moonis M (2009) Use of telemedicine to increase thrombolysis and advance care in acute ischemic stroke. Cerebrovasc Dis 27:9–14. doi:10.1159/000213053

    Article  PubMed  Google Scholar 

  6. Johansson T, Mutzenbach SJ, Ladurner G (2011) Telemedicine in acute stroke care: the TESSA model. J Telemed Telecare 17:268–272. doi:10.1258/jtt.2011.101213

    Article  PubMed  Google Scholar 

  7. Smith EE, Dreyer P, Prvu-Bettger J, Abdullah AR, Palmeri G, Goyette L, McElligott C, Schwamm LH (2008) Stroke center designation can be achieved by small hospitals: the Massachusetts experience. Crit Pathw Cardiol 7:173–177. doi:10.1097/HPC.0b013e318184e2bc

    Article  PubMed  Google Scholar 

  8. Zaidi SF, Jumma MA, Urra XN, Hammer M, Massaro L, Reddy V, Jovin T, Lin R, Wechsler LR (2011) Telestroke-guided intravenous tissue-type plasminogen activator treatment achieves a similar clinical outcome as thrombolysis at a comprehensive stroke center. Stroke 42:3291–3293. doi:10.1161/STROKEAHA.111.625046

    Article  CAS  PubMed  Google Scholar 

  9. Pervez MA, Silva G, Masrur S, Betensky RA, Furie KL, Hidalgo R, Lima F, Rosenthal ES, Rost N, Viswanathan A, Schwamm LH (2010) Remote supervision of IV-tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe. Stroke 41:18–24. doi:10.1161/STROKEAHA.109.560169

    Article  Google Scholar 

  10. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D, Investigators ECASS (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359:1317–1329. doi:10.1056/NEJMoa0804656

    Article  CAS  PubMed  Google Scholar 

  11. IST-3 collaborative group, Sandercock P, Wardlaw JM, Lindley RI, Dennis M, Cohen G, Murray G, Innes K, Venables G, Czlonkowska A, Kobayashi A, Ricci S, Murray V, Berge E, Slot KB, Hankey GJ, Correia M, Peeters A, Matz K, Lyrer P, Gubitz G, Phillips SJ, Arauz A (2012) The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 379:2352–2363. doi:10.1016/S0140-6736(12)60768-5

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, CHU Nancy, Hôpital Central, 29 Avenue du Marechal de Lattre de Tassigny-CO n° 34, 54035, Nancy Cedex, France

    Sébastien Richard & X. Ducrocq

  2. CH Bar le Duc, 1 Boulevard d’Argonne, 55012, Bar le Duc Cedex, France

    K. Lavandier, Y. Zioueche & S. Pelletier

  3. GCS Télésanté Lorraine, 6 Allée de Longchamp, 54600, Villers-les-Nancy, France

    A. Vezain

Authors
  1. Sébastien Richard
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  2. K. Lavandier
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  3. Y. Zioueche
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  4. S. Pelletier
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  5. A. Vezain
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  6. X. Ducrocq
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Correspondence to Sébastien Richard.

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Richard, S., Lavandier, K., Zioueche, Y. et al. Use of telemedicine to manage severe ischaemic strokes in a rural area with an elderly population. Neurol Sci 35, 683–685 (2014). https://doi.org/10.1007/s10072-013-1577-4

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  • DOI: https://doi.org/10.1007/s10072-013-1577-4

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