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

• Published in: Stroke (1970) Vol. 37; no. 7; pp. 1822 - 1827
• Main Authors: AUDEBERT, Heinrich J, KUKLA, Christian, VATANKHAH, Bijan, GOTZLER, Berthold, SCHENKEL, Johannes, HOFER, Stephan, FÜRST, Andrea, HABERL, Roman L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.07.2006
• Subjects: Academic Medical Centers - organization & administration; Adult; Aged; Aged, 80 and over; Antihypertensive Agents - therapeutic use; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Brain Ischemia - diagnostic imaging; Brain Ischemia - drug therapy; Brain Ischemia - pathology; Case Management - organization & administration; Catchment Area (Health); Cerebral Hemorrhage - chemically induced; Computer Communication Networks - organization & administration; Computer Communication Networks - statistics & numerical data; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; Germany; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hospital Departments; Hospitals, Community - organization & administration; Humans; Hypertension - complications; Hypertension - drug therapy; Internal Medicine; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Patient Transfer; Pharmacology. Drug treatments; Pilot Projects; Prospective Studies; Recombinant Proteins - administration & dosage; Recombinant Proteins - adverse effects; Recombinant Proteins - therapeutic use; Remote Consultation - organization & administration; Thrombolytic Therapy - adverse effects; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - adverse effects; Tissue Plasminogen Activator - therapeutic use; Tomography, X-Ray Computed; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Stroke; Nervous system diseases; Serine endopeptidases; Enzyme; Cardiovascular disease; t-Plasminogen activator; Cerebral disorder; Vascular disease; Peptidases; Clinical management; Telemedicine; Central nervous system disease; thrombolysis; Hydrolases; Cerebrovascular disease; Comparative study
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000226741.20629.b2

Systemic thrombolysis is the only therapy proven to be effective for ischemic stroke. Telemedicine may help to extend its use. However, concerns remain whether management and safety of tissue plasminogen activator (tPA) administration after telemedical consultation are equivalent in less experienced hospitals compared with tPA administration in academic stroke centers. During the second year of the ongoing Telemedical Pilot Project for Integrative Stroke Care, all systemic thrombolyses in stroke patients of the 12 regional clinics and the 2 stroke centers were recorded prospectively. Patients' demographics, stroke severity (National Institutes of Health Stroke Scale), frequency of administration, time management, protocol violations, and safety were included in the analysis. In 2004, 115 of 4727 stroke or transient ischemic attack patients (2.4%) in the community hospitals and 110 of 1889 patients in the stroke centers (5.8%) received systemic thrombolysis. Prehospital latencies were shorter in the regional hospitals despite longer distances. Door to needle times were shorter in the stroke centers. Although blood pressure was controlled more strictly in community hospitals, symptomatic intracerebral hemorrhage rate (7.8%) was higher (P=0.14) than in stroke centers (2.7%) but still within the range of the National Institute of Neurological Disorders and Stroke trial. In-hospital mortality rate was low in community hospitals (3.5%) and in stroke centers (4.5%). Although with a lower rate of systemic thrombolysis, there was no evidence of lower treatment quality in the remote hospitals. With increasing numbers of tPA administration and growing training effects, the telestroke concept promises better coverage of systemic thrombolysis in nonurban areas.