Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers.

Autor:	López-Cancio E; Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain., Ribó M; Hospital Universitai Vall d'Hebrón, Barcelona, Spain., Cardona P; Hospital Universitari Bellvitge, Barcelona, Spain., Serena J; Hospital Unversitari Josep Trueta, , Spain, Girona, Spain., Purroy F; Hospital Universitari Arnau de Vilanova, IRBLleida. UdL, Lleida, Spain., Palomeras E; Hospital de Mataró, Barcelona, Spain., Aragonès JM; Consorci Hospitalari de Vic, Barcelona, Spain., Cocho D; Hospital General de Granollers, Barcelona, Spain., Garcés M; Hospital Verge de la Cinta, Tarragona, Spain., Puiggròs E; Hospital Sant Camil, Sant Pere de Ribes, Barcelona, Spain., Soteras I; Hospital de la Cerdanya, Girona, Spain., Cabanelas A; Hospital Palamós, Girona, Spain., Villagrasa D; Hospital d'Igualada, Barcelona, Spain., Catena E; Hospital Comarcal Alt Penedès, Barcelona, Spain., Sanjurjo E; Hospital Comarcal del Pallars, Lleida, Spain., López Claverol N; Fundació Sant Hospital la Seu d'Urgell, Lleida, Spain., Carrión D; Hospital Mora d'Ebre, Tarragona, Spain., López M; Hospital Figueres, Girona, Spain., Abilleira S; Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain.; CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain., Dávalos A; Hospital Germans Trias i Pujol, Barcelona, Spain., Pérez de la Ossa N; Hospital Germans Trias i Pujol, Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	Cerebrovascular diseases (Basel, Switzerland) [Cerebrovasc Dis] 2018; Vol. 46 (1-2), pp. 66-71. Date of Electronic Publication: 2018 Aug 22.
DOI:	10.1159/000492124
Abstrakt:	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. (© 2018 S. Karger AG, Basel.)
Databáze:	MEDLINE
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