title: Can telemedicine contribute to fulfill WHO Helsingborg Declaration of specialized stroke care?
abstract: BACKGROUND
  Providing stroke unit treatment for all stroke patients is a cross-national goal as stated in the WHO Helsingborg Declaration. In order to achieve specialized stroke care for a large area, two stroke centers and 12 community hospitals established an integrative stroke network. This evaluation was performed to analyze achieved advances in stroke management.
  
  
  METHODS
  Core network elements are: (1) establishing stroke wards in all hospitals; (2) continuous training in stroke treatment; (3) telemedicine service staffed by a 24 h/day 'strokologist' with capability for high-speed videoconferencing and transfer of CT/MRI images. Data were prospectively documented in the databank of the telestroke service, in the Bavarian Stroke Registry and in the controlling departments.
  
  
  RESULTS
  In 2003, 4,179 stroke patients were admitted to the regional network hospitals. Between February 2003 and January 2004 a total of 2,182 teleconsultations were conducted. 250 teleconsultations yielded a nonvascular diagnosis. Indicators for stroke management quality improved compared with other hospitals without stroke unit: the frequency of CT/MRI within 3 h was 59% compared to 46%, frequency of speech therapy 36% (21%), and of occupational therapy 38% (12%). Eighty-six (2.1%) of the patients received systemic thrombolysis compared to 10 patients in the preceding year. Mean length of in-hospital stay decreased from 12.4 in 2002 to 9.7 days in 2003.
  
  
  CONCLUSIONS
  This stroke network concept leads to a substantial improvement of stroke management. Telemedicine contributes to an early etiological assessment and fills the gap of specialized stroke expertise in neurologically underserved areas.
authors.affiliation: Abteilung fur Neurologie, Stadtisches Krankenhaus Munchen-Harlaching, Munchen-Harlaching, Deutschland. neuro.audebert@khmh.de
authors.forename: Heinrich J
authors.initials: HJ
authors.lastname: Audebert
authors.forename: Martin L J
authors.initials: ML
authors.lastname: Wimmer
authors.forename: Raymund
authors.initials: R
authors.lastname: Hahn
authors.forename: Johannes
authors.initials: J
authors.lastname: Schenkel
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bogdahn
authors.forename: Markus
authors.initials: M
authors.lastname: Horn
authors.forename: Roman L
authors.initials: RL
authors.lastname: Haberl
mesh_terms: D000208:Acute Disease; D005858:Germany; D006764:Hospitals, Community / Q000458:organization & administration; D006801:Humans; D002546:Ischemic Attack, Transient / Q000628:therapy; D009462:Neurology / Q000458:organization & administration*; D010360:Patient Transfer; D010865:Pilot Projects; D015397:Program Evaluation; D011787:Quality of Health Care; D012042:Registries; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D017216:Telemedicine / Q000458:organization & administration* / Q000592:standards; D049269:Videoconferencing / Q000458:organization & administration / Q000592:standards; D014944:World Health Organization