title: Use of telemedicine to manage severe ischaemic strokes in a rural area with an elderly population.
abstract: The rural district of the Meuse (East France) has a high number of elderly patients for whom prognosis of ischaemic strokes is poor with high-haemorrhagic transformation risk of intravenous tissue plasminogen activator (rt-PA). This disadvantage is made worse by the distances a patient has to travel to the nearest stroke unit. We set out to assess the effectiveness of a telestroke system implemented in this area. Between October 2010 and February 2012, data from each "tele-expertised" patient were collected. 53 patients were examined. Diagnosis of ischaemic stroke was confirmed in 43 cases (81 %), and intravenous rt-PA treatment performed in 21 cases (40 %). In the treated patient group, median age was 73 years, with 29 % of octogenarians. Baseline National Institutes of Health Stroke Scale (NIHSS) was 16, with 29 % ≥ 20. The median onset to needle time was 169 min, and the median door to needle time was 69 min. Intracranial haemorrhage occurred in 3 cases (14 %), and was symptomatic in two (10 %). At 3 months, median NIHSS was 6, 6 patients (29 %) presented a favourable outcome (modified Rankin scale ≤ 1) and 3 (14 %) had died. In rural areas, for elderly patients with severe ischaemic strokes, telemedicine appears to be a way of improving accessibility and benefits of rt-PA treatment.
authors.affiliation: Department of Neurology, CHU Nancy, Hôpital Central, 29 Avenue du Marechal de Lattre de Tassigny-CO n° 34, 54035, Nancy Cedex, France, s.richard@chu-nancy.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Richard
authors.forename: K
authors.initials: K
authors.lastname: Lavandier
authors.forename: Y
authors.initials: Y
authors.lastname: Zioueche
authors.forename: S
authors.initials: S
authors.lastname: Pelletier
authors.forename: A
authors.initials: A
authors.lastname: Vezain
authors.forename: X
authors.initials: X
authors.lastname: Ducrocq
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005602:France; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019035:Rural Health Services / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000628:therapy*; D017216:Telemedicine / Q000379:methods* / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator