The use of telemedicine in combination with a new stroke-code-box significantly increases t-PA use in rural communities

• Published in: Neurocritical care 2005-01, Vol.3 (1), p.27-32
• Main Authors: Ickenstein, Guntram W, Horn, M, Schenkel, J, Vatankhah, B, Bogdahn, U, Haberl, R, Audebert, H J
• Format: Article
• Language: English
• Subjects: Aged; CD-I; Female; Fibrinolytic Agents - therapeutic use; Functional Laterality; Hospitals, Community; Humans; Male; Middle Aged; Rural Population; Stroke; Stroke - classification; Stroke - drug therapy; Telemedicine; Telemedicine - methods; Time Factors; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome
• ISSN: 1541-6933; 1541-6933; 1556-0961
• DOI: 10.1385/NCC:3:1:027

The benefit of tissue plasminogen activator (t-PA) is strongly associated with the time to treatment. In Bavaria, Germany, only half of the population has the opportunity to be transferred to 1 of the 19 stroke units within the critical time window of less than 3 hours. The aim of this study was to investigate the benefit of a new stroke-code-box for t-PA thrombolysis combined with a telemedicine network system to increase the use of acute stroke thrombolysis. Two specialized stroke centers in Germany established a 24-hour telemedicine network (Telemedicine Pilot Project of an Integrated Stroke Care [TEMPiS]) to advise 12 community hospitals in eastern Bavaria. These clinics are linked via telemedicine in a 24-hour/7-day service network that allows patients to be examined by experts via a videoconference system Additionally, a special stroke-code-box for acute t-PA thrombolysis was designed to reduce time in the application and documentation process. In the 12-month period before implementation of the TEMPiS network system, 10 patients had received systemic thrombolysis. In our 6-month study period (from July to December 2003) and after implementation of a stroke-code-box for t-PA thrombolysis within the telestroke network, 164 patients with acute stroke were presented with t-PA treatment indications. Of this patient population, 27.4% (45 of 164) received t-PA. Stroke care, including t-PA thrombolysis in non-urban areas, is feasible using a modern stroke unit concept within a telestroke network. With the expertise of specialized stroke centers accessed via telemedicine and the design of a stroke-code-box for t-PA thrombolysis, nearly one-third of patients presented with a possible indication for systemic thrombolysis can be treated with t-PA, thereby increasing the options for a successful stroke treatment.