title: Telemedicine for safe and extended use of thrombolysis in stroke: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria.
abstract: OBJECTIVE
  Systemic thrombolysis represents the only proven therapy for acute ischemic stroke, but safe treatment is reported only in established stroke units. One major goal of the ongoing Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria is to extend the use of tissue plasminogen activator (tPA) treatment in nonurban areas through telemedic support.
  
  
  METHODS
  The stroke centers in Munich-Harlaching and in Regensburg established a telestroke network to provide consultations for 12 local hospitals in eastern Bavaria. The telemedic system consists of a digital network that includes a 2-way video conference system and CT/MRI image transfer with a high-speed data transmission up to 2 Mb/s. Each network hospital established specialized stroke wards in which qualified teams treat acute stroke patients. Physicians in these hospitals are able to contact the stroke centers 24 hours per day.
  
  
  RESULTS
  A total of 106 systemic thrombolyses were indicated via teleconsultations between February 1, 2003, and April 7, 2004. During the first 12 months, the rate of thrombolyses was 2.1% of all stroke patients. Mean age was 68 years, and median National Institutes of Health Stroke Scale score was 13. Mean delay between onset and hospital admission was 65 minutes, and door-to-needle time was on average 76 minutes, which included 15 minutes for the teleconsultation. Symptomatic hemorrhage occurred in 8.5% of patients, and in-hospital mortality was 10.4%.
  
  
  CONCLUSIONS
  The present data suggest that systemic thrombolysis indicated via stroke experts in the setting of teleconsultation exhibits similar complication rates to those reported in the National Institute of Neurological Disorders and Stroke trial. Therefore, tPA treatment is also safe in this context and can be extended to nonurban areas.
authors.affiliation: Department of Neurology, Städtisches Krankenhaus München-Harlaching, Munich, Germany. neuro.audebert@khmh.de
authors.forename: Heinrich J
authors.initials: HJ
authors.lastname: Audebert
authors.forename: Christian
authors.initials: C
authors.lastname: Kukla
authors.forename: Stephan
authors.initials: S
authors.lastname: Clarmann von Claranau
authors.forename: Johannes
authors.initials: J
authors.lastname: Kühn
authors.forename: Bijan
authors.initials: B
authors.lastname: Vatankhah
authors.forename: Johannes
authors.initials: J
authors.lastname: Schenkel
authors.forename: Guntram W
authors.initials: GW
authors.lastname: Ickenstein
authors.forename: Roman L
authors.initials: RL
authors.lastname: Haberl
authors.forename: Markus
authors.initials: M
authors.lastname: Horn
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000628:therapy; D003201:Computers; D005260:Female; D005858:Germany; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019114:Remote Consultation / Q000379:methods; D020521:Stroke / Q000628:therapy*; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D015912:Thrombolytic Therapy / Q000191:economics / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator