title: Emergency transfer of acute stroke patients within the East Saxony telemedicine stroke network: a descriptive analysis.
abstract: BACKGROUND
  Telemedicine may facilitate the selection of stroke patients who require emergency transfer to a comprehensive stroke center to receive additional therapies other than intravenous tissue plasminogen activator.
  
  
  OBJECTIVE
  We sought to analyze frequency, patient characteristics, and specific therapies among emergently transferred patients within the telemedical Stroke East Saxony Network.
  
  
  METHODS
  We reviewed consecutive patients who were transferred emergently from remote spoke sites to hub sites. Certified stroke neurologists performed teleconsultations 24/7, with access to high-speed videoconferencing and transfer of brain images. Emergent transfers were initiated when considered necessary by the stroke neurologist.
  
  
  RESULTS
  In 2009 and 2010, we conducted 1413 teleconsultations and subsequently recommended transfer in 339 (24%) patients [mean age 64 ± 14 years, 54% males, median National Institutes of Health Stroke Scale score 5 (interquartile range, IQR 12). The mean teleconsultation-to-arrival time was 1·7 ± 0·8 h (median 1·6 h). Sixty-eight (20%) transferred patients had a nonstroke diagnosis. The remaining 271 (80%) patients had stroke diagnoses [ischemic stroke, 114 (34%); transient ischemic attack, 8 (2%); and intracranial haemorrhage, 149 (44%)]. Forty (35%) ischemic stroke patients received tissue plasminogen activator at spoke sites ('drip and ship'). Of the 240 stroke patients emergently transferred to the main hub site, 119 (49·6%) received at least one specific stroke therapy.
  
  
  CONCLUSIONS
  A remarkable number of stroke patients can be transferred within a telemedical network to enable the delivery of specific stroke therapies that require advanced multispecialty expertise. Whether associated logistic efforts and costs have an impact on patients' clinical outcomes needs to be evaluated.
authors.affiliation: Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kepplinger
authors.forename: Imanuel
authors.initials: I
authors.lastname: Dzialowski
authors.forename: Kristian
authors.initials: K
authors.lastname: Barlinn
authors.forename: Volker
authors.initials: V
authors.lastname: Puetz
authors.forename: Claudia
authors.initials: C
authors.lastname: Wojciechowski
authors.forename: Hauke
authors.initials: H
authors.lastname: Schneider
authors.forename: Georg
authors.initials: G
authors.lastname: Gahn
authors.forename: Tobias
authors.initials: T
authors.lastname: Back
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schackert
authors.forename: Heinz
authors.initials: H
authors.lastname: Reichmann
authors.forename: Ruediger
authors.initials: R
authors.lastname: von Kummer
authors.forename: Ulf
authors.initials: U
authors.lastname: Bodechtel
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D019058:Community Networks; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D012189:Retrospective Studies; D020521:Stroke / Q000628:therapy*; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: emergency transfer; stroke; telemedicine