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Abstract
Background: Official guidelines on stroke promote the use of telemedicine via bidirectional videoconferencing equipment, which provides a valid and reliable means of facilitating thrombolysis delivery to patients in distant or rural hospitals.
Methods: The present prospective cohort study describes the characteristics and 3-month outcome of the thrombolysis patients treated in 5 community hospitals served by the Helsinki University Central Hospital (HUCH) in a telestroke network during 2007 to 2009. The characteristics and outcome of telestroke thrombolysis patients are compared with consecutive thrombolysis patients (n = 985) treated at HUCH.
Results: A total of 106 consecutive telestroke consultations in 2 years led to IV thrombolysis in 61 patients (57.5%). The median NIH Stroke Scale score was 10 (range 3–26), onset to treatment time 120 minutes (interquartile range [IQR] 49), length of consultation 25 minutes (IQR 18) if the consultation led to thrombolysis and 15 minutes (IQR 10) if not (p = 0.032). The rate of symptomatic intracranial bleedings was 6.7% (4/60) according to the National Institute of Neurological Disorders and Stroke definition. Half (28/57) of the thrombolysis patients with complete follow-up data had a favorable outcome (modified Rankin Scale [mRS] 0–2) and a third (17/57) had an excellent recovery (mRS 0–1). Thus the patients treated with thrombolysis based on teleconsultation had similar outcome with those treated at HUCH (mRS 0–2: 49.1% vs 58.1%, p = 0.214 and mRS 0–1: 17/57 [29.4%] vs 352/957 [36.8%], p = 0.289).
Conclusions: A special feature of the Finnish pilot is the high percentage of consultations leading to thrombolytic treatment with features and results very similar to on-site thrombolysis at the neurologic emergency room of HUCH.
Footnotes
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Study funding: Supported in part by the State Provincial Office of Southern Finland (Etelä-Suomen Lääninhallitus, ESLH; grant number 004/ESLH/KH/2006). The authors received financial support from the Helsinki University Central Hospital governmental subsidiary EVO funds for clinical research (T.S., T.T.), the Academy of Finland (T.T.), the Finnish Medical Association (T.S., T.T.), and the Finnish Medical Foundation (T.S.). The funding body had no role in data collection, analysis, and interpretation. All researchers had full access to all data. It is solely the researchers' decision to prepare the manuscript, the consistence of the manuscript, and to submit the manuscript.
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Editorial, page 1121
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Supplemental data at www.neurology.org
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- BAO
- basilar artery occlusion
- HSTR
- Helsinki Stroke Thrombolysis Registry
- HUCH
- Helsinki University Central Hospital
- IQR
- interquartile range
- mRS
- modified Rankin Scale
- NIHSS
- NIH Stroke Scale
- NINDS
- National Institute of Neurological Disorders and Stroke
- OTT
- onset to treatment time
- rtPA
- recombinant tissue plasminogen activator
- sICH
- symptomatic intracerebral hemorrhage
- Received June 15, 2010.
- Accepted October 25, 2010.
- Copyright © 2011 by AAN Enterprises, Inc.
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