title: Intracranial hemorrhage: frequency, location, and risk factors identified in a TeleStroke network.
abstract: Intracranial hemorrhages are associated with high rates of disability and mortality. Telemedicine in general provides clinical healthcare at a distance by using videotelephony and teleradiology and is used particularly in acute stroke care medicine (TeleStroke). TeleStroke considerably improves quality of stroke care (for instance, by increasing thrombolysis) and may be valuable for the management of intracranial hemorrhages in rural hospitals and hospitals lacking neurosurgical departments, given that surgical/interventional therapy is only recommended for a subgroup of patients. The aim of this study was to analyze the frequency, anatomical locations of intracranial hemorrhage, risk factors, and the proportion of patients transferred to specialized hospitals. We evaluated teleconsultations conducted between 2008 and 2010 in a large cohort of patients consecutively enrolled in the Telemedical Project for Integrated Stroke Care (TEMPiS) network. In cases in which intracranial hemorrhage was detected, all images were re-examined and analyzed with a focus on frequency, location, risk factors, and further management. Overall, 6187 patients presented with stroke-like symptoms. Intracranial hemorrhages were identified in 631 patients (10.2%). Of these, intracerebral hemorrhages were found in 423 cases (67.0%), including 174 (41.1%) in atypical locations and 227 (53.7%) in typical sites among other locations. After 14 days of hospitalization in community facilities, the mortality rate in patients with intracranial hemorrhages was 15.1% (95/631). Two hundred and twenty-three patients (35.3%) were transferred to neurological/neurosurgical hospitals for diagnostic workup or additional treatment. Community hospitals are confronted with patients with intracranial hemorrhage, whose management requires specific neurosurgical and hematological expertise with respect to hemorrhage subtype and clinical presentation. TeleStroke networks help select patients who need advanced neurological and/or neurosurgical care. The relatively low proportion of interhospital transfers shown in this study reflects a differentiated decision process on the basis of both guidelines and standard operating procedures.
authors.affiliation: aDepartment of Neurology, University of Regensburg, Bezirksklinikum Regensburg bCenter of Neuroradiology, University Medical Center Regensburg, Bezirksklinikum Regensburg cInstitute of Epidemiology and Preventive Medicine, University Medical Center Regensburg - all Regensburg dStädtisches Klinikum München, Klinikum Harlaching, München eKrankenhaus Agatharied, Hausham, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Backhaus
authors.forename: Felix
authors.initials: F
authors.lastname: Schlachetzki
authors.forename: Walter
authors.initials: W
authors.lastname: Rackl
authors.forename: Dobri
authors.initials: D
authors.lastname: Baldaranov
authors.forename: Michael
authors.initials: M
authors.lastname: Leitzmann
authors.forename: Gordian J
authors.initials: GJ
authors.lastname: Hubert
authors.forename: Peter
authors.initials: P
authors.lastname: Müller-Barna
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuierer
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bogdahn
authors.forename: Sandra
authors.initials: S
authors.lastname: Boy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D016208:Databases, Factual; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D006973:Hypertension / Q000150:complications*; D020300:Intracranial Hemorrhages / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017216:Telemedicine; D013997:Time Factors