title: The effect of telestroke systems among neighboring hospitals: more and better? The Madrid Telestroke Project.
abstract: A telestroke system was established between a community hospital lacking an on-call neurologist and a comprehensive stroke center only 13 km away. Our goal was to analyze the impact of telestroke on the number of intravenous thrombolysis (IVT), door-to-needle times and stroke outcomes. An observational before-and-after study of patients with acute ischemic stroke (IS) who were attended in a community hospital during the 2 years before the telestroke system was implemented (pre-telestroke group) and the first 2 years after telestroke was established (telestroke group). The number of IVT, the door-to-needle time (min), the outcomes [modified Rankin Scale (mRS)] and the safety (mortality and hemorrhagic transformations) were compared between groups. During the pre-telestroke years, 259 patients with IS were attended (28 phone activations), 12 of whom received IVT (4.7 %). During the telestroke years, 225 patients with IS were attended (42 telestroke activations), of whom 18 (8 %) received IVT. The door-to-needle times were lower in the telestroke group [median interquartile range: 66 (54) vs. 143.5 (48) min, P < 0.0001]. The safety was similar in both groups; however, the 3-month mRS scores were lower in the telestroke group (P = 0.049). The multiple linear regression analysis showed a negative association between telestroke and door-to-needle time [β-coefficient (SE) = -59.089 (14.461)], adjusted for confounders. In conclusion, telestroke systems are effective, even between nearby hospitals, shortening door-to-needle time and improving stroke outcomes.
authors: Department of Neurology and Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Paseo de la Castellana 261, 28046, Madrid, Spain, patrindalo@hotmail.com.
authors: Patricia
authors: P
authors: Martínez-Sánchez
authors: Ambrosio
authors: A
authors: Miralles
authors: Rosa
authors: R
authors: Sanz de Barros
authors: Daniel
authors: D
authors: Prefasi
authors: Borja E
authors: BE
authors: Sanz-Cuesta
authors: Blanca
authors: B
authors: Fuentes
authors: Gerardo
authors: G
authors: Ruiz-Ares
authors: Marta
authors: M
authors: Martínez-Martínez
authors: Elena
authors: E
authors: Miñano
authors: Juan José
authors: JJ
authors: Arévalo-Manso
authors: Elisa
authors: E
authors: Correas-Callero
authors: Andrés
authors: A
authors: Cruz-Herranz
authors: Exuperio
authors: E
authors: Díez-Tejedor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D017216:Telemedicine / Q000379:methods / Q000706:statistics & numerical data*; D015912:Thrombolytic Therapy / Q000379:methods / Q000706:statistics & numerical data*; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator