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Long-term outcome after thrombolysis in telemedical stroke care

From the Department of Neurology (S.S., B.V., U.B., A.F., M.H.), University of Regensburg; Department of Neurology (C.K., M.H., H.J.A.), Städtisches Klinikum München GmbH, Klinikum Harlaching; and Bad Hersfeld Medical Center (M.H.), Germany.

Address correspondence and reprint requests to Dr. Susanne Schwab, Department of Neurology, University of Regensburg, Universitätsstr. 84, D-93053 Regensburg, Germany Susanne.Schwab-Malek{at}medbo.de

Background: IV thrombolysis represents the most effective acute stroke therapy. However, it is almost exclusively performed in stroke centers and is not available in most community areas. The Telemedical Pilot Project for Integrative Stroke Care (TEMPiS) was started in February 2003. Twelve community hospitals with no or very limited stroke thrombolysis experience and two stroke centers were connected via a network providing online neurologic examination and transfer of neuroradiologic scans. Following recently published preliminary results on acute phase safety of telethrombolysis, the present study reports on its long-term functional outcome.

Methods: Modified Rankin Scale (mRS), Barthel Index (BI), and mortality rate were prospectively collected 3 and 6 months after IV thrombolysis in patients of community network hospitals (telemedical group) and the stroke centers. Values of 95/100 for the BI and 0/1 for the mRS were defined as a favorable outcome.

Results: Over the first 22 months, 170 patients were treated with tPA in the telemedical hospitals and 132 in the stroke center hospitals. Mortality rates were 11.2% vs 11.5% at 3 months (p = 0.55) and 14.2% vs 13% at 6 months (p = 0.45). A good functional outcome after 6 months was found in 39.5% of the telemedical hospitals vs 30.9% of the stroke centers (p = 0.10) for the mRS and 47.1% vs 44.8% (p = 0.44) regarding the BI.

Conclusions: Mortality rates and functional outcomes for telemedicine-linked community hospitals and stroke centers were similar and comparable to the results from randomized trials.

Supplemental data at www.neurology.org

Editorial, see page 819

Disclosure: The Departments of Neurology at the University of Regensburg and at the Städtisches Klinikum München GmbH, Klinikum Harlaching, have participated in studies sponsored by Boehringer Ingelheim/Germany and received financial support for their work. The company also supports the TEMPiS project by delivering Stroke-Code-Boxes for tPA use in the TEMPiS network. Since Boehringer Ingelheim is the only supplier of tPA in Germany, a potential conflict of interest is declared by the authors. Nevertheless, the study was performed and evaluated without influence from this or other companies or sponsors. Dr. Heinrich Audebert has received honoraria from Boehringer Ingelheim/Germany (supplier of tPA) and Meytec GmbH (supplier of the technical support of the network). The remaining authors have reported no further conflicts of interest.

Received June 2, 2006. Accepted in final form March 21, 2007.

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Telemedicine for acute stroke: When virtual is as good as reality

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Neurology 2007 69: 819-820. [Full Text]  

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				S. R. Levine and K. M. McConnochie Telemedicine for acute stroke: When virtual is as good as reality Neurology, August 28, 2007; 69(9): 819 - 820. [Full Text] [PDF]