Abstract
Over 10 years after European approval, thrombolysis is still limited by a restricted time window and non-optimal territorial coverage. Implementation of telestroke can give a growing number of patients access to treatment. We hereby present the first Italian telemedicine study applied to both the acute and the monitoring phase of stroke care. From January 2011 to December 2013, we tested a web-based, drip, and treat interaction model, connecting the cerebrovascular specialist of one hub center to the Emergency Department of a Spoke center. We then compared thrombolysis delivered using the telestroke model with thrombolysis provided at the Hub Stroke Unit at the time when the telemedicine program was activated. Telethrombolysis data were then compared with data from the two main international telestroke projects (TEMPiS and REACH), and other European telestroke studies performed at the time of writing. We collected a total of 131 thrombolysis procedures (25 telethrombolysis and 106 thrombolysis patients at the Stroke Unit). Statistical analysis with the t test yielded no statistically significant differences between the two populations in door-to-scan, door-to-needle (DTN), and onset-to-treatment times (OTT). Our OTT and DTN pathway times were longer than the TEMPiS and REACH studies but comparable with other European telemedicine trials, despite different models of interaction and number of centers. Our study in a northeastern province of Italy confirms the potential of applying telemedicine to a cerebrovascular pathology.
Similar content being viewed by others
References
Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, ECASS, ATLANTIS, NINDS and EPITHET rt-PA Study Group et al (2010) Time to treatment with intravenous alteplase and outcome in stroke: an update pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 375:1695–1703
Donnan GA, Davis SM, Parsons MW, Ma H, Dewey HM, Howells DW (2011) How to make better use of thrombolytic therapy in acute ischemic stroke. Nature Rev Neurol 7:400–409
Katzan IL, Hammer MD, Hixson ED, Furlan AJ, Abou-Chebl A, Nadzam DM, Cleveland Clinic Health System Stroke Quality Improvement Team (2004) Utilization of intravenous tissue plasminogen activator for acute ischemic stroke. Arch Neurol 61:346–350
Rubin MN, Demaerschalk BM (2014) The use of telemedicine in the management of acute stroke. Neurosurg Focus 36(1):E4
Muller-Barna P, Schwamm LH, Haberl RL (2012) Telestroke increases use of acute stroke therapy. Curr Opin Neurol 25:5–10
Nelson RE, Saltzman GM, Skalbrin EJ, Demaerschalk BM, Majersik JJ (2011) The cost-effectiveness of telestroke in the treatment of acute ischemic stroke. Neurology 77:1590–1598
Switzer JA, Demaerschalk BM, Xie J, Fan L, Villa KF, Wu EQ (2013) Cost-effectiveness of hub-and-spoke telestroke networks for the management of acute ischemic stroke from the hospitals’ perspectives. Circ Cardiovasc Quality Outcomes 6:18–26
Switzer JA, Hall C, Gross H, Waller J, Nichols FT, Wang S et al (2009) A web-based telestroke system facilitates rapid treatment of acute ischemic stroke patients in rural emergency departments. J Emerg Med 36:12–18
Hess DC, Wang S, Hamilton W, Lee S, Pardue C, Waller JL et al (2005) REACH: clinical feasibility of a rural telestroke network. Stroke 36:2018–2020
Wang S, Gross H, Lee SB, Pardue C, Waller J, Nichols FT et al (2004) Remote evaluation of acute ischemic stroke in rural community hospitals in Georgia. Stroke 35:1763–1768
Audebert HJ, Kukla C, von Claranau SC, Kuhn J, Vatankhah B, Schenkel J et al (2005) Telemedicine for safe and extended use of thrombolysis in stroke: the telemedicine pilot project for integrative stroke care (TEMPiS) in Baviera. Stroke 36:287–291
Audebert HJ, Kukla C, Vatankhah B, Gotzler B, Schenkel J, Hofer S et al (2006) Comparison of tissue plasminogen activator administration management between telestroke network hospitals and academic stroke centers: the telemedical pilot project for integrative stroke care in Bavaria/Germany. Stroke 37:1822–1827
Muller-Barna P, Hubert GJ, Boy S, Bogdahn U, Wiedmann S, Heuschmann PU, Audebert HJ (2014) Telestroke units serving as a model of care in rural areas: 10-year experience of the telemedical project for integrative stroke care. Stroke 45:2739–2744
Richard S, Lavandier K, Zioueche Y, Pelletier S, Vezain A, Ducrocq X (2014) Use of telemedicine to manage severe ischemic strokes in a rural area with an elderly population. Neurol Sci 35:683–685
Lazaridis C, DeSantis SM, Jauch EC, Adams RJ (2013) Telestroke in South Carolina. J Stroke Cerebrovasc Diseases 22:946–950
Amorim E, Shih M, Koehler SA, Massaro LL, Zaidi SF, Jumaa MA et al (2013) Impact of telemedicine implementation in thrombolytic use for acute ischemic stroke: the University of Pittsburgh medical center telestroke network experience. J Stroke Cerebrovasc Diseases 22:527–531
Pedragosa A, Alvarez-Sabin J, Molina CA, Sanclemente C, Martin MC, Alonso F et al (2009) Impact of a telemedicine system on acute stroke care in a community hospital. J Telemed Telecare 15:260–263
Pedragosa A, Alvarez-Sabin J, Molina CA, Brugues J, Ribò M (2011) Endovenous thrombolysis in a district hospital using the telestroke system. Revista de Neurol 53:139–145
Meyer BC, Raman R, Hemmen T, Obler R, Zivin JA, Rao R et al (2008) Efficacy of site-independet telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study. Lancet Neurol 7:787–795
Agarwal S, Day DJ, Sibson L, Barry PJ, Collas D, Metcalf K et al (2014) Thrombolysis delivery by a regional telestroke network-experience from the UK National Health Service. J Am Heart Assoc 3:e000408
Sairanen T, Soinila S, Nikkanen M, Rantanem K, Mustonoja S, Farkkila M et al (2011) Two years of Finnish telestroke: thrombolysis at spokes equal to that at the hub. Neurology 76:1145–1152
Wiborg A, Widder B (2003) Teleneurology to improve stroke care in rural areas. The telemedicine in stroke in Swabia (TESS) project. Stroke 34:2951–2957
Handschu R, Scibor M, Wacker A, Stark DR, Kohrmann M, Erbguth F et al (2014) Feasibility of certified quality management in a comprehensive stroke care network using telemedicine: STENO project. Research 9:1011–1016
Martinez-Sanchez P, Miralles A, De Barros RS, Prefasi D, Sanz-Cuesta BE, Fuentes B et al (2014) The effect of telestroke systems among neighboring hospitals: more and better? The Madrid Telestroke Project. J Neurol 261:1768–1773
Sanders KA, Figiel C, Kiely JM, Gwynn MW, Johnston LH (2013) Expanding access to intravenous tissue-type plasminogen activator treatment with a practice-based telestroke system. J Stroke Cerebrovasc Diseases 22:e546–e548
Hill E, Whitehead M, MacInnes B, Ellis G, Talbot A, Brodie F et al (2013) The first 100 Thrombolysis cases in a novel Scottish mesh telestroke system. Scott Med J 58:213–216
Audebert HJ, Schenkel J, Heuschmann PU, Bogdahn U, Haberl RL (2006) Effects of the implementation of a telemedical stroke network: the telemedic pilot project for integrative stroke care (TEMPiS) in Bavaria Germany. Lancet Neurol 5:742–748
Schwamm LH, Holloway RG, Amarenco P, Audebert HI, Bakas T, Chumbler NR et al (2009) American Heart Association Stroke Council; interdisciplinary council on peripheral vascular disease. A review of the evidence for the use of telemedicine within stroke system of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke 40:2616–2634
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Source of funding
The research leading to these results has received funding from the European Union under Grant Agreement No. C046273 (HEALTH OPTIMization throUgh telemedicine—Health Optiumum).
Disclosures
None.
Conflict of interest
None.
Rights and permissions
About this article
Cite this article
Nardetto, L., Dario, C., Tonello, S. et al. A one-to-one telestroke network: the first Italian study of a web-based telemedicine system for thrombolysis delivery and patient monitoring. Neurol Sci 37, 725–730 (2016). https://doi.org/10.1007/s10072-016-2569-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-016-2569-y