The use of telemedicine in combination with a new stroke-code-box significantly increases t-PA use in rural communities.
BACKGROUND
The benefit of tissue plasminogen activator (t-PA) is strongly associated with the time to treatment. In Bavaria, Germany, only half of the population has the opportunity to be transferred to 1 of the 19 stroke units within the critical time window of less than 3 hours. The aim of this study was to investigate the benefit of a new stroke-code-box for t-PA thrombolysis combined with a telemedicine network system to increase the use of acute stroke thrombolysis.


METHODS
Two specialized stroke centers in Germany established a 24-hour telemedicine network (Telemedicine Pilot Project of an Integrated Stroke Care [TEMPiS]) to advise 12 community hospitals in eastern Bavaria. These clinics are linked via telemedicine in a 24-hour/7-day service network that allows patients to be examined by experts via a videoconference system Additionally, a special stroke-code-box for acute t-PA thrombolysis was designed to reduce time in the application and documentation process.


RESULTS
In the 12-month period before implementation of the TEMPiS network system, 10 patients had received systemic thrombolysis. In our 6-month study period (from July to December 2003) and after implementation of a stroke-code-box for t-PA thrombolysis within the telestroke network, 164 patients with acute stroke were presented with t-PA treatment indications. Of this patient population, 27.4% (45 of 164) received t-PA.


CONCLUSIONS
Stroke care, including t-PA thrombolysis in non-urban areas, is feasible using a modern stroke unit concept within a telestroke network. With the expertise of specialized stroke centers accessed via telemedicine and the design of a stroke-code-box for t-PA thrombolysis, nearly one-third of patients presented with a possible indication for systemic thrombolysis can be treated with t-PA, thereby increasing the options for a successful stroke treatment.
Ickenstein
Guntram W
GW
Department of Neurology, University of Regensburg, Regensburg, Germany. guntram.ickenstein@medbo.de
Horn
M
M
Schenkel
J
J
Vatankhah
B
B
Bogdahn
U
U
Haberl
R
R
Audebert
H J
HJ
D000368:Aged; D019034:CD-I; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D007839:Functional Laterality; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D020521:Stroke / Q000145:classification / Q000188:drug therapy*; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator