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The effect of telestroke systems among neighboring hospitals: more and better? The Madrid Telestroke Project

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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.

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Acknowledgments

We thank Juliette Siegfried and her team at ServingMED.com for their editorial assistance. This project was provided with grants from Cohesion Funds of the Spanish National Health System, the Mutua Madrileña Foundation and the Spanish Ministry of Science and Innovation (TIN 2011-28523).

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical standards

This study was approved by the local ethics committee of La Paz University Hospital and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients, or their legal representatives if the patient was unable to consent, signed the informed consent in the telestroke group prior to their inclusion in the study.

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Authors and Affiliations

  1. Department of Neurology and Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Paseo de la Castellana 261, 28046, Madrid, Spain

    Patricia Martínez-Sánchez, Daniel Prefasi, Borja E. Sanz-Cuesta, Blanca Fuentes, Gerardo Ruiz-Ares, Elena Miñano, Juan José Arévalo-Manso, Elisa Correas-Callero, Andrés Cruz-Herranz & Exuperio Díez-Tejedor

  2. Neurology Section, Department of Internal Medicine, Infanta Sofía University Hospital, Madrid, Spain

    Ambrosio Miralles & Marta Martínez-Martínez

  3. Emergency Department, Infanta Sofía University Hospital, Madrid, Spain

    Rosa Sanz de Barros

Authors
  1. Patricia Martínez-Sánchez
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  2. Ambrosio Miralles
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  3. Rosa Sanz de Barros
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  4. Daniel Prefasi
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  5. Borja E. Sanz-Cuesta
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  6. Blanca Fuentes
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  7. Gerardo Ruiz-Ares
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  8. Marta Martínez-Martínez
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  9. Elena Miñano
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  10. Juan José Arévalo-Manso
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  11. Elisa Correas-Callero
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  12. Andrés Cruz-Herranz
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  13. Exuperio Díez-Tejedor
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Corresponding authors

Correspondence to Patricia Martínez-Sánchez or Exuperio Díez-Tejedor.

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Martínez-Sánchez, P., Miralles, A., Sanz de Barros, R. et al. The effect of telestroke systems among neighboring hospitals: more and better? The Madrid Telestroke Project. J Neurol 261, 1768–1773 (2014). https://doi.org/10.1007/s00415-014-7419-3

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  • DOI: https://doi.org/10.1007/s00415-014-7419-3

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