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

Abstract

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.

• Authors: Elena López-Cancio, Marc Ribó, Pere Cardona, Joaquín Serena, Francisco Purroy, Ernest Palomeras, Josep Maria Aragonès, Dolores Cocho, Moisés Garcés, Elsa Puiggròs, Iñigo Soteras, Ana Cabanelas, David Villagrasa, Ester Catena, Eduard Sanjurjo, Nuria López Claverol, Dolors Carrión, Mercè López, Sònia Abilleira, Antoni Dávalos, Natalia Pérez de la Ossa, Catalan Stroke Code and Reperfusion Consortium (Cat-SCR)
• Journal: Cerebrovascular diseases (Basel, Switzerland) (Cerebrovasc Dis) Vol. 46 Issue 1-2 Pg. 66-71 ( 2018) ISSN: 1421-9786 [Electronic] Switzerland
• PMID: 30134222 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2018 S. Karger AG, Basel.

Chemical References

• Fibrinolytic Agents

Topics

• Aged
• Aged, 80 and over
• Catchment Area, Health
• Delivery of Health Care, Integrated (trends)
• Disability Evaluation
• Endovascular Procedures (adverse effects, mortality, trends)
• Fibrinolytic Agents (administration & dosage, adverse effects)
• Humans
• Middle Aged
• Patient Transfer (trends)
• Prospective Studies
• Recovery of Function
• Registries
• Remote Consultation (trends)
• Spain
• Stroke (diagnosis, mortality, physiopathology, therapy)
• Thrombolytic Therapy (adverse effects, mortality, trends)
• Time Factors
• Treatment Outcome