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The use of telemedicine in combination with a new stroke-code-box significantly increases t-PA use in rural communities

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Abstract

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 video-conference 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.

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Authors and Affiliations

  1. Department of Neurology, München General Hospital, Munich, Germany

    J. Schenkel, R. Haberl & H. J. Audebert

  2. Department of Neurology, University of Regensburg, Universitaetsstr. 84, 93053, Regensburg, Germany

    Guntram W. Ickenstein, M. Horn, B. Vatankhah & U. Bogdahn

Authors
  1. Guntram W. Ickenstein
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  2. M. Horn
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  3. J. Schenkel
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  4. B. Vatankhah
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  5. U. Bogdahn
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  6. R. Haberl
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  7. H. J. Audebert
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Correspondence to Guntram W. Ickenstein.

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Ickenstein, G.W., Horn, M., Schenkel, J. et al. The use of telemedicine in combination with a new stroke-code-box significantly increases t-PA use in rural communities. Neurocrit Care 3, 27–32 (2005). https://doi.org/10.1385/NCC:3:1:027

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  • DOI: https://doi.org/10.1385/NCC:3:1:027

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